@article{07dcf3887bd24dbe994eadfc470ade09,
title = "Novel handheld ultrasound technology to enhance non-expert screening for rheumatic heart disease in the Republic of Palau: A descriptive study",
abstract = "Aim: Non-expert training in rheumatic heart disease (RHD) detection is a valuable strategy in resource-limited settings. Here we present an innovative handheld ultrasound application featuring views of correct probe position, imaging protocol and echocardiographic loops of RHD pathology versus normal, accessible during real-time scanning. Methods: This prospective study was implemented into a pre-existing school health screening programme at an elementary school in Koror, Palau. Six learners with no prior ultrasound experience were taught a simplified screening protocol in which a mitral regurgitation jet ≥1.5 cm and/or presence of aortic insufficiency were considered a positive screen. All consented children underwent echocardiographic screening by experts with standard portable echocardiography. All positive cases and 25% of negative cases were referred for handheld scans by learners. Results: A total of 26 (4.1%) children were diagnosed with borderline or definite RHD. Mean sensitivity and specificity compared to expert RHD diagnosis over all learners was 71% (standard deviation (SD) 11.3) and 92% (SD 4.9), respectively. For the three highest scanning learners, mean sensitivity was 88% (SD 4.9) and mean specificity was 90% (SD 5.7). For all definite RHD cases, sensitivity was 100% for all but one learner, who achieved sensitivity of 60%. The novel application was used in 229 of 624 (36%) of all handheld scans and 50 of 112 (45%) of expert-diagnosed positive scans, with protocol and reference features most frequently used. Utilisation of the novel application overall decreased per day of scanning per learner. Conclusion: Adjunctive handheld ultrasound technology may help ease non-experts into RHD screening.",
keywords = "cardiology, community, education, international child health",
author = "Sonia Voleti and Myra Adelbai and Ian Hovis and Jessica Colyer and Burns, {Kristin M.} and Lewis, {Elway Olkeriil} and Arurang, {Jason Kalei} and Allyne Kikuharu and Maanne Gonzales and Pedro, {Sheila Judy} and Meghan Zimmerman and Anita Krishnan and Andrea Beaton and Craig Sable and Scott Dougherty",
note = "Funding Information: We would like to acknowledge the staff of the Palauan school screening programme in Koror and the Palauan Ministry of Health, who welcomed and collaborated with us on the infrastructure of this project and enabled sustained RHD screening throughout other Palauan schools as a part of the Palauan school screening programme. This work was supported by internal funding from the Children's National Hospital Global Health Initiative grant, Palauan Ministry of Health funds and General Electric, who provided in‐kind donation of portable and handheld machines for use in Palau. Funds were used for travel, accommodation, supplies during the school screening, and stipend for local personnel assisting with work flow in the school screening programme. Funding Information: We would like to acknowledge the staff of the Palauan school screening programme in Koror and the Palauan Ministry of Health, who welcomed and collaborated with us on the infrastructure of this project and enabled sustained RHD screening throughout other Palauan schools as a part of the Palauan school screening programme. This work was supported by internal funding from the Children's National Hospital Global Health Initiative grant, Palauan Ministry of Health funds and General Electric, who provided in-kind donation of portable and handheld machines for use in Palau. Funds were used for travel, accommodation, supplies during the school screening, and stipend for local personnel assisting with work flow in the school screening programme. Publisher Copyright: {\textcopyright} 2021 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).",
year = "2021",
month = jul,
doi = "10.1111/jpc.15409",
language = "English (US)",
volume = "57",
pages = "1089--1095",
journal = "Journal of Paediatrics and Child Health",
issn = "1034-4810",
publisher = "Wiley-Blackwell",
number = "7",
}