Point‐of‐care ultrasound education for non‐physician clinicians in a resource‐limited emergency department

Stolz, Lori; Muruganandan, Krithika M.; Bisanzo, Mark; Sebikali, Mugisha J.; Dreifuss, Bradley; Hammerstedt, Heather; Nelson, Sara W.; Nayabale, Irene; Adhikari, Srikar; Shah, Sachita

doi:10.1111/tmi.12511

Cited by 68 publications

(53 citation statements)

References 16 publications

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“…[21,22,28,29] In our study, a single charged battery pack was sufficient to power one pOBU for an entire clinic day, with the ability to scan over 40 women. Utilizing pOBU does require initial investment costs, and technical and logistic factors such as training ultrasonographers and obtaining vehicles necessary to access isolated communities.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of advertising availability of prenatal ultrasound on uptake of antenatal care in rural Uganda: A cluster randomized trial

et al. 2017

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In rural Uganda pregnant women often lack access to health services, do not attend antenatal care, and tend to utilize traditional healers/birth attendants. We hypothesized that receiving a message advertising that “you will be able to see your baby by ultrasound” would motivate rural Ugandan women who otherwise might use a traditional birth attendant to attend antenatal care, and that those women would subsequently be more satisfied with care. A cluster randomized trial was conducted across eight rural sub-counties in southwestern Uganda. Sub-counties were randomized to a control arm, with advertisement of antenatal care with no mention of portable obstetric ultrasound (four communities, n = 59), or an intervention arm, with advertisement of portable obstetric ultrasound. Advertisement of portable obstetric ultrasound was further divided into intervention A) word of mouth advertisement of portable obstetric ultrasound and antenatal care (one communitity, n = 16), B) radio advertisement of only antenatal care and word of mouth advertisement of antenatal care and portable obstetric ultrasound (one community, n = 7), or C) word of mouth + radio advertisement of both antenatal care and portable obstetric ultrasound (two communities, n = 75). The primary outcome was attendance to antenatal care. 159 women presented to antenatal care across eight sub-counties. The rate of attendance was 65.1 (per 1000 pregnant women, 95% CI 38.3–110.4) where portable obstetric ultrasound was advertised by radio and word of mouth, as compared to a rate of 11.1 (95% CI 6.1–20.1) in control communities (rate ratio 5.9, 95% CI 2.6–13.0, p<0.0001). Attendance was also improved in women who had previously seen a traditional healer (13.0, 95% CI 5.4–31.2) compared to control (1.5, 95% CI 0.5–5.0, rate ratio 8.7, 95% CI 2.0–38.1, p = 0.004). By advertising antenatal care and portable obstetric ultrasound by radio attendance was significantly improved. This study suggests that women can be motivated to attend antenatal care when offered the concrete incentive of seeing their baby.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of advertising availability of prenatal ultrasound on uptake of antenatal care in rural Uganda: A cluster randomized trial

et al. 2017

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“…To supplement the 47 Ugandan radiologists interpreting medical imaging mostly in cities, many groups, including the Uganda Ministry of Health, have trained technologists (sonographers and radiographers) and midlevel providers to interpret basic ultrasound out in the community (9)(10)(11). Consequently, nonradiologists interpret 70% of the imaging.…”

Section: Introductionmentioning

confidence: 98%

Improving Breast Ultrasound Interpretation in Uganda Using a Condensed Breast Imaging Reporting and Data System

et al. 2016

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“…Other NGOs in Uganda are involved in training sonographers to use basic ultrasound techniques at community health centers (HCIIIs) to triage pregnant women with potential obstetric complications to district hospitals (20)(21)(22). Similarly, ITWA's efforts to train sonographers to characterize breast masses at the level of HCIIIs would not only help to downstage breast cancer, but also reduce the number of women travelling unnecessarily to referral hospitals for nonmalignant breast lumps.…”

Section: Performance Of Front-line Sonographers At Nawanyago Hciiimentioning

confidence: 99%

Pilot Study of a Resource-Appropriate Strategy for Downstaging Breast Cancer in Rural Uganda

Matovu¹,

Shadrack²,

Ssembatya³

et al. 2016

JGR

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Breast cancer incidence and mortality are rapidly increasing in low-and middle-income countries like Uganda. Shifting the proportion of women presenting with late-stage breast cancer to earlystage breast cancer (downstaging) at the time of diagnosis would substantially improve survival and efficient use of available resources. Imaging The World (ITW) conducted a pilot study in Uganda where trained village health teams (VHTs) promoted breast cancer awareness in the Kamuli District (Uganda). As a result, 212 women with self-detected lumps presented to the community health center level III (Nawanyago HCIII) for a clinical breast examination (CBE). Patients with masses on CBE were examined with breast ultrasound by a certified sonographer trained in breast imaging. Women with ultrasound-detected masses were referred to a regional health center for further evaluation. Of the 212 women, 44 (21%) had a palpable mass by CBE, 11 (28%) examined by ultrasound were recommended for biopsy, and four breast cancers were diagnosed. Providing ultrasound scanning at Nawanyago HCIII reduced the number of women travelling to the referral hospital by 75%. As a result of breast cancer awareness and ultrasound studies, we were able to diagnose breast cancer at an earlier stage than would be otherwise possible. This pilot project supports locally available breast ultrasound as a resource-appropriate strategy to downstage breast cancer in a low-income country. I S S N 2 3 7 2 -8 4 1 8 in large numbers of patients. Therefore, given the resources, the most resource-appropriate strategy seems to be downstaging through health awareness leading to increased rates of BSE and CBE.According to the Breast Health Global Initiative (BHGI) guidelines, resource-appropriate strategies to downstage breast cancer in Uganda should include increased breast health awareness, so women begin to practice BSE and present early to their providers after self-detecting a lump (9, 10). It is also important to train the providers in breast health to obtain appropriate history and physical examination including a proper CBE. Both BSE and CBE have the potential for a high false-positive rate and are, therefore, no longer recommended in countries where screening mammography is available (11-13). But, with one publically available mammography unit in the country, screening mammography is not a feasible option for most Ugandan women, particularly rural women. Ultrasound is more widely available, even in rural areas, and has the ability to characterize palpable masses detected by CBE as those requiring biopsy versus those that can safely be managed by imaging or clinical follow-up (14).In accordance with the World Health Organization's recommendations to reduce the global burden of breast cancer (15), Imaging The World (ITW) developed a resource-appropriate strategy to downstage breast cancer. ITW is a non-profit organization with a global team of volunteers who provide ultrasound training, equipment and technology in LMICs to improve and sustain health outcomes...

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Point‐of‐care ultrasound education for non‐physician clinicians in a resource‐limited emergency department

Cited by 68 publications

References 16 publications

Effectiveness of advertising availability of prenatal ultrasound on uptake of antenatal care in rural Uganda: A cluster randomized trial

Effectiveness of advertising availability of prenatal ultrasound on uptake of antenatal care in rural Uganda: A cluster randomized trial

Improving Breast Ultrasound Interpretation in Uganda Using a Condensed Breast Imaging Reporting and Data System

Pilot Study of a Resource-Appropriate Strategy for Downstaging Breast Cancer in Rural Uganda

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