Danny Epstein1, Neta Petersiel2, Erez Klein3, Erez Marcusohn2, Eyal Aviran4, Reut Harel5, Zaher S Azzam6, Ami Neuberger7, Lior Fuchs8. 1. Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel. Electronic address: D_EPSTEIN@rambam.health.gov.il. 2. Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel. 3. Department of Diagnostic Imaging, Rambam Health Care Center, Haifa, Israel. 4. Hadassah-Hebrew University Medical Center, Jerusalem, Israel. 5. Department of Internal Medicine "C", Emek Medical Center, Afula, Israel. 6. Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel; The Rappaport's Faculty of Medicine, The Technion Institute, Haifa, Israel. 7. Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel; The Rappaport's Faculty of Medicine, The Technion Institute, Haifa, Israel; Division of Infectious Diseases, Rambam Health Care Center, Haifa, Israel. 8. Medical Intensive Care Unit, Soroka Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Abstract
BACKGROUND: In the developing world, only a small minority of patients have access to radiological services. Over the past decade, technological developments of ultrasound equipment have led to the emergence of point-of-care ultrasonography (POCUS), which is widely used by healthcare professionals of nearly all specialties. We hypothesized that physicians with only basic POCUS training, but with telemedicine support, can use POCUS successfully in rural hospitals in sub-Saharan Africa. METHOD: During a 14-day voluntary clinical work session in a rural hospital in central Uganda, bedside ultrasound scans were performed by use of a pocket-size portable machine by a physician who underwent a five-day training period. All the POCUS studies were reviewed by radiologists and cardiologists abroad with the use of telemedicine. RESULTS: During the study period, 30% of patients received a POCUS-augmented physical examination. 16 out of 23 patients (70%) had positive findings; in 20 of them (87%), the management was changed. The technique was successfully used on trauma casualties, patients suffering from shock, patients with cardiorespiratory symptoms, and patients undergoing invasive procedures. CONCLUSIONS: In a very resource-limited environment, POCUS conducted by basically trained primary care physicians with telemedicine support is a powerful diagnostic tool in a variety of medical conditions.
BACKGROUND: In the developing world, only a small minority of patients have access to radiological services. Over the past decade, technological developments of ultrasound equipment have led to the emergence of point-of-care ultrasonography (POCUS), which is widely used by healthcare professionals of nearly all specialties. We hypothesized that physicians with only basic POCUS training, but with telemedicine support, can use POCUS successfully in rural hospitals in sub-Saharan Africa. METHOD: During a 14-day voluntary clinical work session in a rural hospital in central Uganda, bedside ultrasound scans were performed by use of a pocket-size portable machine by a physician who underwent a five-day training period. All the POCUS studies were reviewed by radiologists and cardiologists abroad with the use of telemedicine. RESULTS: During the study period, 30% of patients received a POCUS-augmented physical examination. 16 out of 23 patients (70%) had positive findings; in 20 of them (87%), the management was changed. The technique was successfully used on trauma casualties, patients suffering from shock, patients with cardiorespiratory symptoms, and patients undergoing invasive procedures. CONCLUSIONS: In a very resource-limited environment, POCUS conducted by basically trained primary care physicians with telemedicine support is a powerful diagnostic tool in a variety of medical conditions.
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