Objectives
To review the scientific literature pertaining to the use of hand‐carried and hand‐held ultrasound devices in low‐ and middle‐income countries (LMIC), with a focus on clinical ...applications, geographical areas of use, the impact on patient management and technical features of the devices used.
Methods
The electronic databases PubMed and Google Scholar were searched. No language or date restrictions were applied. Case reports and original research describing the use of hand‐carried ultrasound devices in LMIC were included if agreed upon as relevant by two‐reviewer consensus based on our predefined research questions.
Results
A total of 644 articles were found and screened, and 36 manuscripts were included for final review. Twenty‐seven studies were original research articles, and nine were case reports. Several reports describe the successful diagnosis and management of difficult, often life‐threatening conditions, using hand‐carried and hand‐held ultrasound. These portable ultrasound devices have also been studied for cardiac screening exams, as well as a rapid triage tool in rural areas and after natural disaster. Most applications focus on obstetrical and abdominal complaints. Portable ultrasound may have an impact on clinical management in up to 70% of all cases. However, no randomised controlled trials have evaluated the impact of ultrasound‐guided diagnosis and treatment in resource‐constrained settings. The exclusion of articles published in journals not listed in the large databases may have biased our results. Our findings are limited by the lack of higher quality evidence (e.g. controlled trials).
Conclusions
Hand‐carried and hand‐held ultrasound is successfully being used to triage, diagnose and treat patients with a variety of complaints in LMIC. However, the quality of the current evidence is low. There is an urgent need to perform larger clinical trials assessing the impact of hand‐carried ultrasound in LMIC.
Objectifs
Passer en revue la littérature scientifique portant sur l'utilisation d'appareils d’échographie portatifs dans les pays à faible revenu et à revenu intermédiaire (PFR‐PRI) en mettant l'accent sur les applications cliniques, les zones géographiques d'utilisation, l'impact sur la prise en charge des patients et les caractéristiques techniques des appareils utilisés.
Méthodes
Recherche effectuée dans les bases de données électroniques PubMed et Google Scholar. Aucune restriction linguistique ou de période n'a été appliquée. Les rapports de cas et les recherches originales décrivant l'utilisation d'appareils d’échographie portatifs dans les PFR‐PRI ont été inclus, si trouvés pertinents par le consensus de deux reviewers, basé sur nos questions de recherche prédéfinies.
Résultats
644 articles ont été trouvés et analysés, 36 manuscrits ont été inclus pour analyse finale. 27 études faisaient l'objet d'articles de recherche originale et 9 étaient des rapports de cas. Plusieurs rapports décrivent le diagnostic et la prise en charge avec succès de conditions difficiles, souvent mortelles, en utilisant des appareils d’échographie portatifs. Ces dispositifs d’échographie portatifs ont également été étudiés pour les examens de dépistage cardiaques, ainsi que comme outil de triage rapide dans les zones rurales et à la suite de catastrophes naturelles. La plupart des applications se concentrent sur les plaintes obstétricales et abdominales. L’échographie portative peut avoir un impact sur la prise en charge clinique dans 70% de tous les cas. Cependant, aucun essai contrôlé randomisé n'a évalué l'impact sur le diagnostic et le traitement guidé par l’échographie dans les milieux à ressources limitées. L'exclusion des articles publiés dans des revues ne figurant pas dans les grandes bases de données peut avoir biaisé nos résultats. Nos résultats sont limités par le manque de donnée de meilleure qualité (par ex., les essais contrôlés).
Conclusions
L’échographie portative et réalisée à la main est utilisée avec succès au triage, au diagnostic et pour le traitement des patients avec diverses plaintes dans PFR‐PRI. Cependant, la qualité des données actuelles est faible. Il est urgent de procéder à des essais cliniques de grande envergure évaluant l'impact de l’échographie réalisée à la main dans les PFR‐PRI.
Objetivos
Revisar la literatura científica existente sobre el uso de aparatos portátiles de ultrasonido en países con ingresos bajos y medios (PIBM), con especial atención en las aplicaciones clínicas, las áreas geográficas de uso, el impacto sobre el manejo del paciente y las características técnicas de los aparatos utilizados.
Métodos
Se realizó una búsqueda en las bases de datos electrónicas PubMed y Google Scholar. No se aplicaron restricciones de idioma o fecha. Se incluyeron los informes de casos y artículos originales que describían el uso de aparatos de ultrasonido portátiles en PIBM, si dos revisores estaban de acuerdo sobre su relevancia basándose en las preguntas predefinidas de búsqueda.
Resultados
Se encontraron y revisaron 644 artículos, y se incluyeron 36 manuscritos en la revisión final. 27 estudios eran artículos de investigaciones originales y 9 eran informes de casos. Varios informes describan el diagnóstico exitoso y el manejo de condiciones difíciles, a menudo letales, utilizando equipos portátiles de ultrasonido. Estos equipos también han sido estudiados en pruebas de riesgo cardiaco, al igual que como herramientas de triaje rápido en áreas rurales y después de un desastre natural. La mayoría de las aplicaciones se centran en problemas obstétricos y abdominales. El ultrasonido portátil podría tener un impacto sobre el manejo clínico en hasta un 70% de todos los casos. Sin embargo, ningún ensayo aleatorizado y controlado ha evaluado el impacto del diagnóstico y el tratamiento guiado por ultrasonido en lugares con recursos limitados. Excluir aquellos artículos publicados en revistas que no figuran en las grandes bases de datos podría haber sesgado nuestros resultados. Nuestros hallazgos están limitados por la falta de evidencia de mayor calidad (ej. ensayos controlados).
Conclusiones
El uso de equipos de ultrasonido portátiles es exitoso para realizar el triaje, diagnóstico y tratamiento de pacientes con una variedad de problemas en PIBM. Sin embargo, la calidad de la evidencia actualmente disponible es baja. Existe una necesidad urgente de realizar ensayos clínicos grandes para evaluar el impacto de equipos de ultrasonido portátiles en PIBM.
Background Diarrheal disease is a leading cause of morbidity and mortality globally, especially in low- and middle-income countries. High-throughput and low-cost approaches to identify etiologic ...agents are needed to guide public health mitigation. Nanoliter-qPCR (nl-qPCR) is an attractive alternative to more expensive methods yet is nascent in application and without a proof-of-concept among hospitalized patients. Methods A census-based study was conducted among diarrheal patients admitted at two government hospitals in rural Bangladesh during a diarrheal outbreak period. DNA was extracted from stool samples and assayed by nl-qPCR for common bacterial, protozoan, and helminth enteropathogens as the primary outcome. Results A total of 961 patients were enrolled; stool samples were collected from 827 patients. Enteropathogens were detected in 69% of patient samples; More than one enteropathogen was detected in 32%. Enteropathogens most commonly detected were enteroaggregative Escherichia coli (26.0%), Shiga toxin-producing E.coli (18.3%), enterotoxigenic E. coli (15.5% heat stable toxin positive, 2.2% heat labile toxin positive), Shigella spp. (14.8%), and Vibrio cholerae (9.0%). Geospatial analysis revealed that the median number of pathogens per patient and the proportion of cases presenting with severe dehydration were greatest amongst patients residing closest to the study hospitals." Conclusions This study demonstrates a proof-of-concept for nl-qPCR as a high-throughput low-cost method for enteropathogen detection among hospitalized patients.
This technical report describes the successful transition from dual lumen, single site veno-venous extracorporeal membrane oxygenation ((dl)V-V ECMO) to single lumen, dual site veno-pulmonary (V-P) ...ECMO, and subsequently to dual lumen, single site (dl)V-P ECMO involving temporary placement of two cannulas in the main pulmonary artery. No complications were observed during these transitions. This technique could address concerns related to cannula exchanges in VP ECMO. However, caution is warranted and constant monitoring of cannula position using real-time imaging is required when using this technique due to the risk profile.
Deep hypothermic circulatory arrest (DHCA) is often required for patients undergoing repair of descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm via left thoracotomy when ...proximal crossclamping is not feasible or when aneurysmal disease extends into the transverse aortic arch. Historical literature suggests higher complications rates due to the technical complexity of this approach; we examined outcomes with this approach at our center.
Between January 2008 and May 2018, 84 patients with DTAA or Crawford extent I thoracoabdominal aortic aneurysm underwent open repair. DHCA was employed in 46 of 84 (55%) patients, of which 33 (72%) required repair of distal arch and DTAA, and 13 (28%) required repair of the distal arch and extent I thoracoabdominal aortic aneurysm. Patients who underwent DHCA had more chronic dissections than those in the non-DHCA group (70% vs 34%; P ≤ .05).
Major adverse outcomes for the DHCA group versus non-DHCA group were as follows: early mortality 3 out of 46 (7%) versus 4 out of 38 (11%) (P = .70), stroke 3 out of 46 (7%) versus 1 out of 38 (3%) (P = .62), permanent spinal cord deficit 2 out of 46 (4%) versus 3 out of 38 (8%) (P = .65), permanent renal failure necessitating dialysis 1 out of 46 (2%) versus 2 out of 38 (5%) (P = .59). Freedom from major adverse outcomes was 38 out of 46 (83%) versus 31 out of 38 (82%) for DHCA versus non-DHCA (P = 1).
DHCA can be employed via left thoracotomy for combined arch and DTAA or extent I thoracoabdominal aortic aneurysm open repair.
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Early bystander cardiopulmonary resuscitation (CPR) has been associated with better patient outcomes in cardiac arrest. Despite this, not all cases of cardiac arrest receive bystander intervention. ...Reasons for this gap include disparities in provision of bystander CPR between race, gender and age groups. Concern of legal liability for responders has also been described. We propose that bystanders are more likely to face litigation for lack of intervention compared to providing bystander CPR due to the presence of ‘Good Samaritan’ statutes in all 50 states. This review of the legal literature seeks to quantify the number of cases brought against bystanders in the US over the past 30 years and explore the reasons behind them.
The Westlaw legal research database was searched for jury verdicts, settlements, and appellate opinions from all 50 states from 1989 to 2019 for personal injury or wrongful death lawsuits involving CPR. Of 506 cases manually reviewed by the authors, 170 were directly related to CPR. Case details including jurisdiction, location, date, plaintiff and defendant demographics, level of training of CPR provider, relationship to patient, motivation for the lawsuit, and case outcomes were recorded.
Our data show a significant difference in the number of cases of cases alleging battery versus negligence regarding provision of CPR. Of 170 cases, 167 were due to inadequate or untimely bystander CPR. Three cases alleging harm due to providing CPR were identified.
This study represents the largest single study of legal cases involving bystander CPR in the medical literature. The likelihood of litigation is significantly higher in cases with bystander CPR absent or delayed. The authors propose the inclusion of this data and reiteration of ‘Good Samaritan’ statutes in all 50 states during CPR training to reassure and encourage public response to cardiac arrests.
Point-of-care ultrasound at the bedside has evolved into an essential component of emergency patient care. Current evidence supports its use across a wide spectrum of medical and traumatic diseases ...in a variety of settings. The prehospital use of ultrasound has evolved from a niche technology to impending widespread adoption across emergency medical services systems internationally. Recent technological advances and a growing evidence base support this trend. However, concerns regarding feasibility, education, and quality assurance must be addressed proactively. This topical review describes the history of prehospital ultrasound, initial training needs, ongoing skill maintenance, quality assurance and improvement requirements, available devices, and indications for prehospital ultrasound.
Determine the clinical safety and feasibility of implementing a telemedicine and medication delivery service (TMDS) to address gaps in nighttime access to health care for children in low-resource ...settings.
We implemented a TMDS called ‘MotoMeds’ in Haiti as a prospective cohort study. A parent/guardian of a sick child ≤ 10 years contacted the call center (6 PM-5 AM). A nurse provider used decision support tools to triage cases (mild, moderate, or severe). Severe cases were referred to emergency care. For nonsevere cases, providers gathered clinical findings to generate an assessment and plan. For cases within the delivery zone, a provider and driver were dispatched and the provider performed a paired in-person exam as a reference standard for the virtual call center exam. Families received a follow-up call at 10 days. Data were analyzed for clinical safety and feasibility.
A total of 391 cases were enrolled from September 9, 2019, to January 19, 2021. Most cases were nonsevere (92%; 361); household visits were completed for 89% (347) of these cases. Among the 30 severe cases, 67% (20) sought referred care. Among all cases, respiratory problems were the most common complaint (63%; 246). At 10 days, 95% (329) of parents reported their child had “improved” or “recovered”. Overall, 99% (344) rated the TMDS as “good” or “great”. The median phone consultation time was 20 minutes, time to household arrival was 73 minutes, and total case time was 114 minutes.
The TMDS was a feasible health care delivery model. Although many cases were likely self-limiting, the TMDS was associated with high rates of reported improvement in clinical status at 10 days.
clinicaltrials.gov: NCT03943654.
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