{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T07:54:01Z","timestamp":1793778841701,"version":"4.6.1"},"reference-count":14,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2015,9,3]]},"published-print":{"date-parts":[[2016,1,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Handheld echocardiography (HAND) has good sensitivity and specificity for rheumatic heart disease (RHD) when performed by cardiologists. However, physician shortages in RHD-endemic areas demand less-skilled users to make RHD screening practical. We examine nurse performance and interpretation of HAND using a simplified approach for RHD screening.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Two nurses received training on HAND and a simplified screening approach. Consented students at two schools in Uganda were eligible for participation. A simplified approach (HAND performed and interpreted by a non-expert) was compared with the reference standard (standard portable echocardiography, performed and interpreted by experts according to the 2012 World Heart Federation guidelines). Reasons for false-positive and false-negative HAND studies were identified.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 1002 children were consented, with 956 (11.1\u2005years, 41.8% male) having complete data for review. Diagnoses included: 913 (95.5%) children were classified normal, 32 (3.3%) borderline RHD and 11 (1.2%) definite RHD. The simplified approach had a sensitivity of 74.4% (58.8% to 86.5%) and a specificity of 78.8% (76.0% to 81.4%) for any RHD (borderline and definite). Sensitivity improved to 90.9% (58.7% to 98.5%) for definite RHD. Identification and measurement of erroneous colour jets was the most common reason for false-positive studies (n=164\/194), while missed mitral regurgitation and shorter regurgitant jet lengths with HAND were the most common reasons for false-negative studies (n=10\/11).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Non-expert-led HAND screening programmes offer a potential solution to financial and workforce barriers that limit widespread RHD screening. Nurses trained on HAND using a simplified approach had reasonable sensitivity and specificity for RHD screening. Information on reasons for false-negative and false-positive screening studies should be used to inform future training protocols, which could lead to improved screening performance.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2015-308236","type":"journal-article","created":{"date-parts":[[2015,10,5]],"date-time":"2015-10-05T22:48:24Z","timestamp":1444085304000},"page":"35-39","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":114,"title":["Handheld echocardiographic screening for rheumatic heart disease by non-experts"],"prefix":"10.1136","volume":"102","author":[{"given":"Michelle","family":"Ploutz","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiology, Children's National Health System, Washington DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmy C","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Children's National Health System, Washington DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Scheel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Children's National Health System, Washington DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Webb","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg J","family":"Ensing","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Twalib","family":"Aliku","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Children's National Health System, Washington DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Lwabi","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Sable","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Children's National Health System, Washington DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Beaton","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Children's National Health System, Washington DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,10,5]]},"reference":[{"key":"2025092003574189000_102.1.35.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61728-0"},{"key":"2025092003574189000_102.1.35.2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(64)90132-2"},{"key":"2025092003574189000_102.1.35.3","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(92)90070-4"},{"key":"2025092003574189000_102.1.35.4","doi-asserted-by":"publisher","DOI":"10.3111\/13696998.2015.1006366"},{"key":"2025092003574189000_102.1.35.5","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.092312"},{"key":"2025092003574189000_102.1.35.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa065085"},{"key":"2025092003574189000_102.1.35.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2010.01.364"},{"key":"2025092003574189000_102.1.35.8","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeu296"},{"key":"2025092003574189000_102.1.35.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2013.09.013"},{"key":"2025092003574189000_102.1.35.10","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2012.7"},{"key":"2025092003574189000_102.1.35.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2015.01.001"},{"key":"2025092003574189000_102.1.35.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2025092003574189000_102.1.35.13","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.114.002324"},{"key":"2025092003574189000_102.1.35.14","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951112001321"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/heartjnl-2015-308236","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T10:57:50Z","timestamp":1758365870000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/heartjnl-2015-308236"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10,5]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2015,12,11]]},"published-print":{"date-parts":[[2016,1,1]]}},"alternative-id":["10.1136\/heartjnl-2015-308236"],"URL":"https:\/\/doi.org\/10.1136\/heartjnl-2015-308236","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"value":"1355-6037","type":"print"},{"value":"1468-201X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,10,5]]}}}