Patricia C. Henwood

A Practical Guide to Self-Sustaining Point-of-Care Ultrasound Education Programs in Resource-Limited Settings

The value of point-of-care ultrasound education in resource-limited settings is increasingly recognized, though little guidance exists on how to best construct a sustainable training program. Herein we offer a practical overview of core factors to consider when developing and implementing a point-of-care ultrasound education program in a resource-limited setting. Considerations include analysis of needs assessment findings, development of locally relevant curriculum, access to ultrasound machines and related technological and financial resources, quality assurance and follow-up plans, strategic partnerships, and outcomes measures. Well-planned education programs in these settings increase the potential for long-term influence on clinician skills and patient care.

Characterizing the limited use of point-of-care ultrasound in Colombian emergency medicine residencies

BackgroundEmergency medicine (EM) is a growing specialty in Colombia with five residency programs in the country. EM leadership is interested in incorporating point-of-care (POC) ultrasound into a standardized national EM residency curriculum. This study is a nationwide survey of Colombian EM residents designed to explore the current state of POC ultrasound use within EM residencies and examine specific barriers preventing its expansion.MethodsWe conducted a mix-methodology study of all available current EM residents in the five EM residencies in Colombia. The quantitative survey assessed previous ultrasound experience, current use of various applications, desire for further training, and perceived barriers to expanded use. Focus group discussions (FGDs) were conducted with current EM residents to gather additional qualitative insight into their practice patterns and perceived barriers to clinician-performed ultrasound.ResultsSixty-nine EM residents completed the quantitative survey, a response rate of 85% of all current EM residents in Colombia; 52% of resident respondents had previously used ultrasound during their training. Of these, 58% indicated that they had performed <10 scans and 17% reported >40 scans. The most frequently used applications indicated by respondents were trauma, obstetrics, and procedures including vascular access. A quarter indicated they had previously received some ultrasound training, but almost all expressed an interest in learning more. Significant barriers included lack of trained teachers (indicated by 78% of respondents), absence of machines (57%), and limited time (41%). In FGDs, the barriers identified were inter-specialty conflicts over the control of ultrasonography, both institutionally and nationally, and program-specific curriculum decisions to include POC ultrasound.ConclusionWhile currently limited in their access, EM residents in Colombia have a strong interest in integrating POC ultrasound into their training. Current barriers to expanded use include traditional barriers such as a lack of equipment seen in many developing countries, as well as inter-specialty conflicts typical of developed countries. Further collaboration is underway to help overcome these obstacles and integrate POC ultrasound into Colombian EM residency training.

Ebola Virus Disease and Pregnancy: A Retrospective Cohort Study of Patients Managed at 5 Ebola Treatment Units in West Africa

Summary We find no evidence to support a difference in the risk of death among pregnant women with suspected or confirmed Ebola virus disease (EVD) as compared to nonpregnant women. Limited data suggest poor fetal and neonatal outcomes in EVD-affected pregnancies.

Point-of-Care Ultrasound Use, Accuracy, and Impact on Clinical Decision Making in Rwanda Hospitals

Few studies of point‐of‐care ultrasound training and use in low resource settings have reported the impact of examinations on clinical management or the longer‐term quality of trainee‐performed studies. We characterized the long‐term effect of a point‐of‐care ultrasound program on clinical decision making, and evaluated the quality of clinician‐performed ultrasound studies.

Academic Medical Support to the Ebola Virus Disease Outbreak in Liberia

During the Ebola Virus Disease (EVD) epidemic in West Africa (2014-2016), many faculty, staff, and trainees from U.S. academic medical centers (i.e., teaching hospitals and their affiliated medical schools; AMCs) wished to contribute to the response to the outbreak, but many barriers prevented their participation. Here, the authors describe a successful long-term academic collaboration in Liberia that facilitated participation in the EVD response. This Perspective outlines the role the authors played in the response (providing equipment and training, supporting the return of medical education), the barriers they faced (logistical and financial), and elements that contributed to their success (partnering and coordinating their response with both U.S. and African institutions). There is a paucity of literature discussing the role of AMCs in disaster response, so the authors discuss the lessons learned and offer suggestions about the responsibilities that AMCs have and the roles they can play in responding to disaster situations.

Evaluation of Noncommercial Ultrasound Gels for Use in Resource-Limited Settings: Evaluation of Noncommercial Ultrasound Gels

Ultrasound (US) is increasingly used in settings where commercial US gel is unavailable. This study evaluated noncommercial gel recipes compared to commercial gel.

Eight-year-old boy presenting with abdominal distention after blunt trauma in Liberia

An 8-year-old boy presented with abdominal distension 1 week after a wall collapsed on him. Immediately after the injury, he developed abdominal distension. He was treated at an outside hospital and observed overnight. No imaging was available and he was discharged home the following day. His abdominal distension recurred the next day. He presented to another outside hospital and was referred to our institution. Examination was remarkable for abdominal tenderness and distention with neither guarding nor rebound. …

Focused assessment with sonography for HIV-associated tuberculosis (FASH) case series from a Rwandan district hospital

Introduction The majority of HIV-TB co-infection worldwide is reported in Africa. The risk of developing extra-pulmonary tuberculosis (EPTB) increases as immune deficiency progresses but is difficult to diagnose. Point-of-care ultrasonography (POCUS) can be an effective adjunct to identify and treat EPTB-associated findings using the focused assessment with sonography for HIV-associated TB (FASH) protocol. Case report Three HIV-infected patients without known history of EPTB presented to a Rwandan district hospital with fever and unclear infection. Initial testing did not reveal a source. Each patient was then evaluated with the FASH protocol by a Rwandan emergency physician with POCUS training. All patients had findings suggestive of EPTB by ultrasound. Anti-TB treatment was initiated, and all subsequently demonstrated symptom improvement. Discussion This case series demonstrates the additional clinical information obtained. It describes how management was changed using POCUS and the FASH in a resource-limited setting in Rwanda and calls for further FASH protocol validation studies.

Interactive medical case. A Liberian health care worker with fever.

This interactive feature presents a 52-year-old woman with fever and muscle and joint pain. She also reported the development of headache, anorexia, nausea, mild diarrhea, and mild chest pains in the preceding 1 to 2 days. Test your diagnostic and therapeutic skills at NEJM.org.