{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T04:43:28Z","timestamp":1773204208875,"version":"3.50.1"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T00:00:00Z","timestamp":1620777600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T00:00:00Z","timestamp":1620777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Cardiovasc Disord"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Point-of-care cardiac ultrasound (cardiac POCUS) has potential to become a useful tool for improving cardiovascular care in Tanzania. We conducted a pilot program to train clinicians at peripheral health centers to obtain and interpret focused cardiac POCUS examinations using a hand-held portable device.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Over a 5-day period, didactic and experiential methods were used to train clinicians to conduct a pre-specified scanning protocol and recognize key pathologies. Pre- and post-training knowledge and post-training image acquisition competency were assessed. In their usual clinical practices, trainees then scanned patients with cardiovascular signs\/symptoms, recorded a pre-specified set of images for each scan, and documented their interpretation as to presence or absence of key pathologies on a case report form. A cardiologist subsequently reviewed all images, graded them for image quality, and then documented their interpretation of key pathologies in a blinded fashion; the cardiologist interpretation was considered the gold standard.\n<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>8 trainees (6 Clinical Officers, 1 Assistant Medical Officer, and 1 Medical Doctor) initiated and completed the training. Trainees subsequently performed a total of 429 cardiac POCUS examinations in their clinical practices over a 9\u00a0week period. Stratified by trainee, the median percent of images that were of sufficient quality to be interpretable was 76.7% (range 18.0\u201394.2%). For five of eight trainees, 75% or more of images were interpretable. For detection of pre-specified key pathologies, kappa statistics for agreement between trainee and cardiologist ranged from \u2212\u00a00.03 (no agreement) for detection of pericardial effusion to 0.42 (moderate agreement) for detection of tricuspid valve regurgitation. Mean kappa values across the key pathologies varied by trainee from 0 (no agreement) to 0.32 (fair agreement).\n<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The 5-day training program was sufficient to train most clinicians to obtain basic cardiac images but not to accurately interpret them. Proficiency in image interpretation may require a more intensive training program.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12872-021-02045-y","type":"journal-article","created":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T12:03:00Z","timestamp":1620820980000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Feasibility of point-of-care cardiac ultrasound performed by clinicians at health centers in Tanzania"],"prefix":"10.1186","volume":"21","author":[{"given":"Delilah","family":"Kimambo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Kennedy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Engerasiya","family":"Kifai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neema","family":"Kailembo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christie","family":"Eichberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Markosky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ishan","family":"Shah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Powers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Zwerner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan E.","family":"Dorman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Janabi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Bayer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,5,12]]},"reference":[{"key":"2045_CR1","doi-asserted-by":"publisher","first-page":"S6","DOI":"10.5830\/CVJA-2015-036","volume":"26","author":"GA Mensah","year":"2015","unstructured":"Mensah GA, et al. Mortality from cardiovascular diseases in sub-Saharan Africa, 1990\u20132013: a systematic analysis of data from the Global Burden of Disease Study 2013. Cardiovasc J Afr. 2015;26:S6\u201310.","journal-title":"Cardiovasc J Afr"},{"key":"2045_CR2","doi-asserted-by":"publisher","first-page":"2449","DOI":"10.1161\/CIRCULATIONAHA.118.037367","volume":"138","author":"AK Amegah","year":"2018","unstructured":"Amegah AK. Tackling the growing burden of cardiovascular diseases in sub-Saharan Africa. Circulation. 2018;138:2449\u201351.","journal-title":"Circulation"},{"key":"2045_CR3","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/S1473-3099(05)70267-X","volume":"5","author":"JR Carapetis","year":"2005","unstructured":"Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005;5:685\u201394.","journal-title":"Lancet Infect Dis"},{"key":"2045_CR4","doi-asserted-by":"publisher","first-page":"e438","DOI":"10.1016\/S2214-109X(14)70234-7","volume":"2","author":"BM Mayosi","year":"2014","unstructured":"Mayosi BM, Gamra H, Dangou JM, Kasonde J. Rheumatic heart disease in Africa: the Mosi-o-Tunya call to action. Lancet Glob Health. 2014;2:e438\u20139.","journal-title":"Lancet Glob Health"},{"key":"2045_CR5","doi-asserted-by":"publisher","first-page":"e0147926","DOI":"10.1371\/journal.pone.0147926","volume":"11","author":"E Maimela","year":"2016","unstructured":"Maimela E, Alberts M, Modjadji SE, Choma SS, Dikotope SA, Ntuli TS, Van Geertruyden JP. The prevalence and determinants of chronic non-communicable disease risk factors amongst adults in the Dikgale Health Demographic and Surveillance System (HDSS) Site, Limpopo Province of South Africa. PLoS ONE. 2016;11:e0147926. https:\/\/doi.org\/10.1371\/journal.pone.0147926.","journal-title":"PLoS ONE"},{"key":"2045_CR6","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1016\/S0140-6736(08)60417-1","volume":"371","author":"K Sliwa","year":"2008","unstructured":"Sliwa K, Wilkinson D, Hansen C, Ntyintyane L, Tibazarwa K, Becker A, Stewart S. Spectrum of heart disease and risk factors in a black urban population in South Africa (the Heart of Soweto Study): a cohort study. Lancet. 2008;371:915\u201322. https:\/\/doi.org\/10.1016\/S0140-6736(08)60417-1.","journal-title":"Lancet"},{"key":"2045_CR7","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/1744-8603-5-10","volume":"5","author":"R BeLue","year":"2009","unstructured":"BeLue R, Okoror TA, Iwelunmor J, Taylor KD, Degboe AN, Agyemang C, Ogedegbe G. An overview of cardiovascular risk factor burden in sub-Saharan African countries: a socio-cultural perspective. Glob Health. 2009;5:10. https:\/\/doi.org\/10.1186\/1744-8603-5-10.","journal-title":"Glob Health"},{"key":"2045_CR8","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1007\/s12245-008-0074-7","volume":"1","author":"S Adler","year":"2008","unstructured":"Adler S, Mgalula K, Price D, Taylor O. Introduction of portable ultrasound unit into the health services of the Lugufu refugee camp, Kigoma district, Tanzania. Int J Emerg Med. 2008;1:261\u20136.","journal-title":"Int J Emerg Med"},{"issue":"10","key":"2045_CR9","doi-asserted-by":"publisher","first-page":"e78450","DOI":"10.1371\/journal.pone.0078450","volume":"8","author":"AB Ross","year":"2013","unstructured":"Ross AB, DeStigter KK, Rielly M, Souza S, Morey GE, Nelson M, Silfen EZ, Garra B, Matovu A, Kawooya MG. A low-cost ultrasound program leads to increased antenatal clinic visits and attended deliveries at a health care clinic in rural Uganda. PLoS ONE. 2013;8(10):e78450.","journal-title":"PLoS ONE"},{"key":"2045_CR10","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1097\/RUQ.0000000000000142","volume":"31","author":"MG Kawooya","year":"2015","unstructured":"Kawooya MG, Nathan RO, Swanson J, Swanson DL, Namulema E, Ankunda R, Kirumira F, Ddungu-Matovu P. Impact of introducing routine antenatal ultrasound services on reproductive health indicators in Mpigi District, Central Uganda. Ultrasound Q. 2015;31:285\u20139.","journal-title":"Ultrasound Q"},{"key":"2045_CR11","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1038\/jp.2014.54","volume":"34","author":"JO Swanson","year":"2014","unstructured":"Swanson JO, Kawooya MG, Swanson DL, Hippe DS, Dungu-Matova P, Nathan R. The diagnostic impact of limited, screening obstetric ultrasound when performed by midwives in rural Uganda. J Perinatol. 2014;34:508\u201312.","journal-title":"J Perinatol"},{"key":"2045_CR12","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.amjmed.2008.07.022","volume":"122","author":"LD Martin","year":"2009","unstructured":"Martin LD, Howell EE, Ziegelstein RC, et al. Hand-carried ultrasound performed by hospitalists: does it improve the cardiac physical examination? Am J Med. 2009;122:35\u201341.","journal-title":"Am J Med"},{"key":"2045_CR13","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1016\/j.jcmg.2014.05.011","volume":"7","author":"M Mehta","year":"2014","unstructured":"Mehta M, Jacobson T, Peters D, et al. Handheld ultrasound versus physical examination in patients referred for transthoracic echocardiography for a suspected cardiac condition. JACC Cardiovasc Imaging. 2014;7:983\u201390.","journal-title":"JACC Cardiovasc Imaging"},{"key":"2045_CR14","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.1111\/echo.12910","volume":"32","author":"V Di Bello","year":"2015","unstructured":"Di Bello V, La Carrubba S, Conte L, SIEC (Italian Society of Cardiovascular Echography), et al. Incremental value of pocket-sized echocardiography in addition to physical examination during inpatient cardiology evaluation: a multicenter Italian study (SIEC). Echocardiography. 2015;32:1463\u201370.","journal-title":"Echocardiography"},{"issue":"22","key":"2045_CR15","doi-asserted-by":"publisher","first-page":"2178","DOI":"10.1161\/CIRCULATIONAHA.117.026622","volume":"136","author":"MA Chamsi-Pasha","year":"2017","unstructured":"Chamsi-Pasha MA, Sengupta PP, Zoghbi WA. Handheld echocardiography: current state and future perspectives. Circulation. 2017;136(22):2178\u201388.","journal-title":"Circulation"},{"key":"2045_CR16","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1093\/ehjci\/jes140","volume":"14","author":"VF Panoulas","year":"2013","unstructured":"Panoulas VF, Daigeler AL, Malaweera AS, et al. Pocket-size hand-held cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors. Eur Heart J Cardiovasc Imaging. 2013;14:323\u201330.","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2045_CR17","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1016\/j.echo.2014.08.001","volume":"27","author":"TM Stokke","year":"2014","unstructured":"Stokke TM, Ruddox V, Sarvari SI, et al. Brief group training of medical students in focused cardiac ultrasound may improve diagnostic accuracy of physical examination. J Am Soc Echocardiogr. 2014;27:1238\u201346.","journal-title":"J Am Soc Echocardiogr"},{"key":"2045_CR18","doi-asserted-by":"publisher","first-page":"1319","DOI":"10.1016\/j.echo.2011.07.013","volume":"24","author":"R Razi","year":"2011","unstructured":"Razi R, Estrada JR, Doll J, et al. Bedside hand-carried ultrasound by internal medicine residents versus traditional clinical assessment for the identification of systolic dysfunction in patients admitted with decompensated heart failure. J Am Soc Echocardiogr. 2011;24:1319\u201324.","journal-title":"J Am Soc Echocardiogr"},{"key":"2045_CR19","doi-asserted-by":"publisher","first-page":"e0204087","DOI":"10.1371\/journal.pone.0204087","volume":"13","author":"L Fuchs","year":"2018","unstructured":"Fuchs L, Gilad D, Mizrakli Y, Sadeh R, Galante O, Kobal S. Self-learning of point-of-care cardiac ultrasound\u2014can medical students teach themselves? PLoS ONE. 2018;13:e0204087.","journal-title":"PLoS ONE"},{"issue":"3","key":"2045_CR20","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1016\/j.echo.2013.12.006","volume":"27","author":"TR Cawthorn","year":"2014","unstructured":"Cawthorn TR, Nickel C, O\u2019Reilly M, et al. Development and evaluation of methodologies for teaching focused cardiac ultrasound skills to medical students. J Am Soc Echocardiogr. 2014;27(3):302\u20139. https:\/\/doi.org\/10.1016\/j.echo.2013.12.006.","journal-title":"J Am Soc Echocardiogr"},{"issue":"4","key":"2045_CR21","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1016\/j.jcmg.2017.06.019","volume":"11","author":"SP Bhavnani","year":"2018","unstructured":"Bhavnani SP, Sola S, Adams D, et al. A randomized trial of pocket-echocardiography integrated mobile health device assessments in modern structural heart disease clinics. JACC Cardiovasc Imaging. 2018;11(4):546\u201357. https:\/\/doi.org\/10.1016\/j.jcmg.2017.06.019.","journal-title":"JACC Cardiovasc Imaging"},{"issue":"1","key":"2045_CR22","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.echo.2014.09.001","volume":"28","author":"M Bansal","year":"2015","unstructured":"Bansal M, Singh S, Maheshwari P, et al. Value of interactive scanning for improving the outcome of new-learners in transcontinental tele-echocardiography (VISION-in-Tele-Echo) study. J Am Soc Echocardiogr. 2015;28(1):75\u201387. https:\/\/doi.org\/10.1016\/j.echo.2014.09.001.","journal-title":"J Am Soc Echocardiogr"},{"key":"2045_CR23","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","volume":"33","author":"JR Landis","year":"1977","unstructured":"Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159\u201374.","journal-title":"Biometrics"},{"key":"2045_CR24","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.1017\/S1047951116002511","volume":"27","author":"AS Sanyahumbi","year":"2017","unstructured":"Sanyahumbi AS, Sable CA, Karlsten M, Hosseinipour MC, Kazembe PN, Minard CG, Penny DJ. Task shifting to clinical officer-led echocardiography screening for detecting rheumatic heart disease in Malawi, Africa. Cardiol Young. 2017;27:1133\u20139.","journal-title":"Cardiol Young"},{"key":"2045_CR25","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1136\/heartjnl-2015-308236","volume":"102","author":"M Ploutz","year":"2016","unstructured":"Ploutz M, Lu J, Scheel J, Webb C, Ensing GJ, Aliku T, Lwabi P, Sable C, Beaton A. Handheld echocardiographic screening for rheumatic heart disease by non-experts. Heart. 2016;102:35\u20139.","journal-title":"Heart"}],"container-title":["BMC Cardiovascular Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-021-02045-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12872-021-02045-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-021-02045-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T12:03:03Z","timestamp":1620820983000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmccardiovascdisord.biomedcentral.com\/articles\/10.1186\/s12872-021-02045-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,12]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2045"],"URL":"https:\/\/doi.org\/10.1186\/s12872-021-02045-y","relation":{},"ISSN":["1471-2261"],"issn-type":[{"value":"1471-2261","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,12]]},"assertion":[{"value":"23 November 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 April 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 May 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The IRBs of the Medical University of South Carolina and the Jakaya Kikwete Cardiac Institute reviewed the protocol and determined that this study was exempt from Human Research Subject Regulations under 45 CFR 46.104(d) for educational practices; written informed consent was not applicable for this exempt educational activity. All methods were carried out in accordance with relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"239"}}