{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T00:07:33Z","timestamp":1771632453717,"version":"3.50.1"},"reference-count":28,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2020,5,28]],"date-time":"2020-05-28T00:00:00Z","timestamp":1590624000000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The Ricbac Foundation"},{"name":"The Rotary Club of Kiama"},{"DOI":"10.13039\/501100024744","name":"The Snow Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100024744","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100012661","name":"Menzies School of Health Research","doi-asserted-by":"publisher","award":["NHMRC Grant Number 1131932"],"award-info":[{"award-number":["NHMRC Grant Number 1131932"]}],"id":[{"id":"10.13039\/100012661","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004374","name":"Medtronic","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004374","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Mal'ala Health Service"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,5,6]]},"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Rheumatic heart disease (RHD) causes significant morbidity and mortality in young people from disadvantaged populations. Early detection through echocardiography screening can facilitate early access to treatment. Large-scale implementation of screening could be feasible with the combination of inexpensive standalone ultrasound transducers and upskilling non-expert practitioners to perform abbreviated echocardiography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A prospective cross-sectional study will evaluate an abbreviated echocardiography screening protocol for the detection of latent (asymptomatic) RHD in high-risk populations. The study will evaluate the diagnostic accuracy of health worker conducted single parasternal long axis view with a sweep using handheld devices (SPLASH) (Philips Lumify S4-1 phased array transducer). Each participant will have at least one reference test performed on the same day by an expert echocardiographer. Diagnosis of RHD will be determined by a panel of three experts, using 2012 World Heart Federation criteria. Sensitivity and specificity of the index test will be calculated with 95% CIs, to determine diagnostic accuracy of a screen-and-refer approach to echocardiography screening for RHD. Remote review of SPLASH images obtained by health workers will facilitate evaluation of the sensitivity and specificity of an alternative approach, using external review of health worker obtained SPLASH images to decide onward referral.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics approval was obtained from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research, for the project to be carried out in Timor-Leste (HREC 2019-3399), and in Australia, following review by the Aboriginal Ethics subcommittee (HREC 2019-334). Ethical and technical approval was granted in Timor-Leste, by the Institute National of Health Research Ethics and Technical Committee (1073-MS-INS\/GDE\/VII\/2019). Study results will be disseminated in the communities involved in the study, and through peer-reviewed publications and conference abstracts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>The Australia New Zealand Clinical Trials Registry (ACTRN12620000122954).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-037609","type":"journal-article","created":{"date-parts":[[2020,5,28]],"date-time":"2020-05-28T06:25:31Z","timestamp":1590647131000},"page":"e037609","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["The RECARDINA Study protocol: diagnostic utility of ultra-abbreviated echocardiographic protocol for handheld machines used by non-experts to detect rheumatic heart disease"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9302-4543","authenticated-orcid":false,"given":"Joshua Reginald","family":"Francis","sequence":"first","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia"},{"name":"Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"Fairhurst","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gillian","family":"Whalley","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Otago Dunedin School of Medicine, Dunedin, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Kaethner","sequence":"additional","affiliation":[{"name":"NT Cardiac, Darwin, Northern Territory, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Ralph","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia"},{"name":"Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Yan","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia"},{"name":"Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Cush","sequence":"additional","affiliation":[{"name":"Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicki","family":"Wade","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andre","family":"Monteiro","sequence":"additional","affiliation":[{"name":"Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor-Leste"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Remenyi","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia"},{"name":"Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,5,27]]},"reference":[{"key":"2025121411201184000_10.5.e037609.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603693"},{"key":"2025121411201184000_10.5.e037609.2","doi-asserted-by":"crossref","first-page":"221","DOI":"10.5694\/mja15.00139","article-title":"Rheumatic heart disease in Indigenous children in northern Australia: differences in prevalence and the challenges of screening","volume":"203","author":"Roberts","year":"2015","journal-title":"Med J Aust"},{"key":"2025121411201184000_10.5.e037609.3","doi-asserted-by":"crossref","first-page":"303","DOI":"10.5694\/mja17.00666","article-title":"Rheumatic heart disease in Timor\u2010Leste school students: an echocardiography\u2010based prevalence study","volume":"208","author":"Davis","year":"2018","journal-title":"Medical Journal of Australia"},{"key":"2025121411201184000_10.5.e037609.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.020966"},{"key":"2025121411201184000_10.5.e037609.5","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.116.003498","article-title":"Rheumatic heart disease severity, progression and outcomes: a Multi\u2010State model","volume":"6","author":"Cannon","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"2025121411201184000_10.5.e037609.6","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1038\/nrcardio.2012.157","article-title":"Screening for rheumatic heart disease: current approaches and controversies","volume":"10","author":"Roberts","year":"2013","journal-title":"Nat Rev Cardiol"},{"key":"2025121411201184000_10.5.e037609.7","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-308635"},{"key":"2025121411201184000_10.5.e037609.8","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeu296"},{"key":"2025121411201184000_10.5.e037609.9","unstructured":"JC L , Sable C , Ensing GJ , et al . Simplified rheumatic heart disease screening criteria for handheld echocardiography. J Am Soc Echocardiogr 2015."},{"key":"2025121411201184000_10.5.e037609.10","doi-asserted-by":"crossref","unstructured":"Mirabel M , Bacquelin R , Tafflet M , et al . Screening for rheumatic heart disease: evaluation of a focused cardiac ultrasound approach. Circ Cardiovasc Imaging 2014.","DOI":"10.1161\/CIRCIMAGING.114.002324"},{"key":"2025121411201184000_10.5.e037609.11","doi-asserted-by":"crossref","first-page":"e386","DOI":"10.1016\/S2214-109X(16)30065-1","article-title":"Focused cardiac ultrasound screening for rheumatic heart disease by briefly trained health workers: a study of diagnostic accuracy","volume":"4","author":"Engelman","year":"2016","journal-title":"Lancet Glob Health"},{"key":"2025121411201184000_10.5.e037609.12","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-308236"},{"key":"2025121411201184000_10.5.e037609.13","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1017\/S1047951117001676","article-title":"A focussed single-view hand-held echocardiography protocol for the detection of rheumatic heart disease","volume":"28","author":"Diamantino","year":"2018","journal-title":"Cardiol Young"},{"key":"2025121411201184000_10.5.e037609.14","doi-asserted-by":"crossref","unstructured":"Francis J , Fairhurst H , Kaethner A , et al . P3133Single parasternal long axis echocardiography by briefly trained health workers using handheld devices for detection of rheumatic heart disease: a prospective study of diagnostic accuracy. Eur Heart J 2019;40.doi:10.1093\/eurheartj\/ehz745.0208","DOI":"10.1093\/eurheartj\/ehz745.0208"},{"key":"2025121411201184000_10.5.e037609.15","article-title":"Single Parasternal-Long-Axis-View-Sweep screening echocardiographic protocol to detect rheumatic heart disease: a prospective study of diagnostic accuracy","author":"Remenyi","year":"2019","journal-title":"Heart Lung Circ"},{"key":"2025121411201184000_10.5.e037609.16","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2012.7"},{"key":"2025121411201184000_10.5.e037609.17","doi-asserted-by":"crossref","unstructured":"Paratz ED , Bayley N . Heart disease in East Timor: cross-sectional analysis of 474 patients attending Timor-Leste\u2019s first cardiology service. Intern Med J 2017.","DOI":"10.1016\/j.hlc.2017.06.686"},{"key":"2025121411201184000_10.5.e037609.18","doi-asserted-by":"crossref","unstructured":"Paratz ED , Mock N , Gutman SJ , et al . Taking the pulse of Timor\u2010Leste's cardiac needs: a ten\u2010year descriptive time\u2010trend analysis. Intern Med J 2019.doi:10.1111\/imj.14411","DOI":"10.1016\/j.hlc.2019.06.127"},{"key":"2025121411201184000_10.5.e037609.19","unstructured":"Australian Bureau of statistics. 2016 census QuickStats, 2016. Available: https:\/\/quickstats.censusdata.abs.gov.au\/census_services\/getproduct\/census\/2016\/quickstat\/IARE704003"},{"key":"2025121411201184000_10.5.e037609.20","unstructured":"Engelman D , Watson C , Remenyi B , et al . Echocardiographic diagnosis of rheumatic heart disease: nurse training modules. Available: http:\/\/www.wiredhealthresources.net\/EchoProject\/ [Accessed 2020 Jan 19]."},{"key":"2025121411201184000_10.5.e037609.21","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.ijcard.2019.02.058","article-title":"The world heart Federation criteria raise the threshold of diagnosis for mild rheumatic heart disease: three reviewers are better than one","volume":"291","author":"Culliford-Semmens","year":"2019","journal-title":"Int J Cardiol"},{"key":"2025121411201184000_10.5.e037609.22","doi-asserted-by":"publisher","DOI":"10.1136\/heartasia-2019-011233"},{"key":"2025121411201184000_10.5.e037609.23","doi-asserted-by":"publisher","DOI":"10.1136\/emj.20.5.453"},{"key":"2025121411201184000_10.5.e037609.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2025121411201184000_10.5.e037609.25","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.029936"},{"key":"2025121411201184000_10.5.e037609.26","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.118.007928","article-title":"Simplified echocardiography screening criteria for diagnosing and predicting progression of latent rheumatic heart disease","volume":"12","author":"Nunes","year":"2019","journal-title":"Circ Cardiovasc Imaging"},{"key":"2025121411201184000_10.5.e037609.27","unstructured":"Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (2nd edition) 2012 RhD Australia, National heart Foundation of Australia and the cardiac Society of Australia and New Zealand"},{"key":"2025121411201184000_10.5.e037609.28","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.ahj.2019.06.001","article-title":"Determining the impact of benzathine penicillin G prophylaxis in children with latent rheumatic heart disease (goal trial): study protocol for a randomized controlled trial","volume":"215","author":"Beaton","year":"2019","journal-title":"Am Heart J"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-037609","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T19:20:19Z","timestamp":1765740019000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-037609"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5]]},"references-count":28,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,5,27]]},"published-print":{"date-parts":[[2020,5]]}},"alternative-id":["10.1136\/bmjopen-2020-037609"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-037609","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5]]}}}