title: Pilot study of nurse-led rheumatic heart disease echocardiography screening in Fiji--a novel approach in a resource-poor setting.
abstract: We designed a pilot study of a training module for nurses to perform rheumatic heart disease echocardiography screening in a resource-poor setting. The aim was to determine whether nurses given brief, focused, basic training in echocardiography could follow an algorithm to potentially identify cases of rheumatic heart disease requiring clinical referral, by undertaking basic two-dimensional and colour Doppler scans. Training consisted of a week-long workshop, followed by 2 weeks of supervised field experience. The nurses' skills were tested on a blinded cohort of 50 children, and the results were compared for sensitivity and specificity against echocardiography undertaken by an expert, using standardised echocardiography definitions for definite and probable rheumatic heart disease. Analysis of the two nurses' results revealed that when a mitral regurgitant jet length of 1.5 cm was used as the trigger for rheumatic heart disease identification, they had a sensitivity of 100% and 83%, respectively, and a specificity of 67.4% and 79%, respectively. This pilot supports the principle that nurses, given brief focused training and supervised field experience, can follow an algorithm to undertake rheumatic heart disease echocardiography in a developing country setting to facilitate clinical referral with reasonable accuracy. These results warrant further research, with a view to developing a module to guide rheumatic heart disease echocardiographic screening by nurses within the existing public health infrastructure in high-prevalence, resource-poor regions.
authors.affiliation: International Health Division, Menzies School of Health Research, Darwin, Australia. samantha.colquhoun@menzies.edu.au
authors.forename: Samantha M
authors.initials: SM
authors.lastname: Colquhoun
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Carapetis
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Kado
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Reeves
authors.forename: Boglarka
authors.initials: B
authors.lastname: Remenyi
authors.forename: William
authors.initials: W
authors.lastname: May
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Wilson
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Steer
mesh_terms: D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology; D002648:Child; D003906:Developing Countries; D004452:Echocardiography / Q000451:nursing; D018618:Echocardiography, Doppler, Color / Q000451:nursing*; D004506:Education, Nursing / Q000379:methods*; D005367:Fiji; D006295:Health Resources; D006801:Humans; D008403:Mass Screening; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D010865:Pilot Projects; D057184:Practice Patterns, Nurses'; D012214:Rheumatic Heart Disease / Q000150:complications / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity