{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:21:18Z","timestamp":1789147278033,"version":"build-2803163510"},"reference-count":9,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T00:00:00Z","timestamp":1614124800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006775","name":"GE Healthcare","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006775","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004313","name":"General Electric","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004313","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>Non\u2010expert training in rheumatic heart disease (RHD) detection is a valuable strategy in resource\u2010limited 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\u2010time scanning.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective study was implemented into a pre\u2010existing 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 \u22651.5\u00a0cm 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u2010diagnosed positive scans, with protocol and reference features most frequently used. Utilisation of the novel application overall decreased per day of scanning per learner.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Adjunctive handheld ultrasound technology may help ease non\u2010experts into RHD screening.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jpc.15409","type":"journal-article","created":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T09:30:36Z","timestamp":1614159036000},"page":"1089-1095","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Novel handheld ultrasound technology to enhance non\u2010expert screening for rheumatic heart disease in the Republic of Palau: A descriptive study"],"prefix":"10.1111","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2544-5818","authenticated-orcid":false,"given":"Sonia","family":"Voleti","sequence":"first","affiliation":[{"name":"Division of Pediatric Cardiology Loma Linda University Children's Hospital  Loma Linda California United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myra","family":"Adelbai","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine Belau National Hospital and Ministry of Health  Koror Republic of Palau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Hovis","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology Children's National Hospital  Washington DC United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Colyer","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology Children's National Hospital  Washington DC United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin M","family":"Burns","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology Children's National Hospital  Washington DC United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elway Olkeriil","family":"Lewis","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine Belau National Hospital and Ministry of Health  Koror Republic of Palau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason Kalei","family":"Arurang","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine Belau National Hospital and Ministry of Health  Koror Republic of Palau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allyne","family":"Kikuharu","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine Belau National Hospital and Ministry of Health  Koror Republic of Palau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maanne","family":"Gonzales","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine Belau National Hospital and Ministry of Health  Koror Republic of Palau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila Judy","family":"Pedro","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine Belau National Hospital and Ministry of Health  Koror Republic of Palau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology Dartmouth\u2010Hitchcock Medical Center  Lebanon New Hampshire United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology Children's National Hospital  Washington DC United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Beaton","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Sable","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology Children's National Hospital  Washington DC United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Dougherty","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine Belau National Hospital and Ministry of Health  Koror Republic of Palau"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,24]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.03.074"},{"key":"e_1_2_7_3_1","first-page":"261","volume-title":"Acute Rheumatic Fever and Rheumatic Heart Disease","author":"Beaton 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