BACKGROUND: Over 90％ of all cases of malaria worldwide occur in Africa. Current methods of diagnosis are time and labor intensive, and could lead to delayed treatment. METHODS: In this study we investigated the effectiveness of measurements of spleen, liver, and optic nerve sheath diameter (ONSD) in identifying patients with malaria or severe malaria through the use of hand-held ultrasound devices. We recruited 40 adult patients with malaria and 16 adult control subjects at two hospitals in Mwanza, Tanzania. Ultrasonographic diagnosis was compared with rapid antigen diagnostic test and peripheral blood smear as the gold standards. An receiver operating characteristic curve test was performed to determine the most optimal diagnostic threshold for malaria and severe malaria, using each of the measurements for liver size, spleen size, and ONSD. The thresholds were determined to be >12 cm for spleen length and >15.1 cm for liver length, whereas ONSD was not significant in this study. RESULTS: The sensitivities for malaria diagnosis were 66.7％ and 58.3％ for liver and spleen length respectively, suggesting that these measurements may not be suitable for identifying patients with severe malaria. However, the high specificity of 90.9％ for spleen length and the acceptable specificity of 75.0％ for liver length suggest that these measurements can be used as a method to eliminate false-positive diagnoses (i.e. patients who do not have severe malaria but are classified as having it by a test with a high sensitivity), giving a high positive predictive value. CONCLUSIONS: We report a high specificity for spleen size and a moderate specificity for liver size in the ultrasonographic diagnosis of severe malaria. Thus when paired with a highly sensitive method of malaria diagnosis, ultrasonographic measurement of spleen and liver size is promising as part of a diagnostic algorithm for malaria. It could be used to stratify risk in patients diagnosed with malaria and assist in their triage. If no sensitive tests are available, ultrasound might be useful to suggest malaria as a cause of a patient's constellation of clinical symptoms.

BACKGROUND:Maternal and infant mortality rates reported in rural Panama are greater than those in urban regions. Bocas del Toro is a region of Panama inhabited by indigenous people at greater risk for pregnancy-related complications and deaths due to geographic isolation and limited access to health care. Portable ultrasound training programs have recently been implemented in low-resource settings to increase access to diagnostic imaging. The goal of this study is to determine the feasibility of teaching first-year medical students the Rural Obstetrical Ultrasound Triage Exam (ROUTE) to help identify pathology in pregnant women of the Bocas del Toro region of Panama. METHODS:Eight first-year medical students completed ROUTE training sessions. After training, the students were compared to professional sonographers to evaluate their accuracy in performing the ROUTE. Students then performed the ROUTE in mobile clinics within Bocas del Toro. They enrolled women pregnant in their 2nd or 3rd trimesters and measured biparietal diameter, head circumference, amniotic fluid index, fetal lie and placental position. Any abnormal measurement would be further analyzed by the lead physician for a potential hospital referral. RESULTS:A total of 60 women were enrolled in the study. Four women were detected as having a possible high-risk pregnancy and thus referred to a hospital for further evaluation. CONCLUSION:Based on our data, first-year medical students with additional training can use the ROUTE to identify complications in pregnancy using ultrasound in rural Panama. Additional studies are required to determine the optimal amount of training required for proficiency.

PURPOSE: This study aimed to assess the impact of ultrasound simulation (SonoSim) on educational outcomes of an introductory point-of-care ultrasound course compared to hands-on training with live models alone. METHODS: Fifty-three internal medicine residents without ultrasound experience were randomly assigned to control or experimental groups. They participated in an introductory point-of-care ultrasound course covering eight topics in eight sessions from June 23, 2014 until July 18, 2014. Both participated in lecture and hands-on training, but experimental group received an hour of computerized simulator training instead of a second hour of hands-on training. We assessed clinical knowledge and image acquisition with written multiple-choice and practical exams, respectively. Of the 53 enrolled, 40 participants (75.5%) completed the course and all testing. RESULTS: For the 30-item written exam, mean score of the experimental group was 23.1±3.4 (n=21) vs. 21.8±4.8 (n=19), (P>0 .05). For the practical exam, mean score for both groups was 8.7 out of 16 (P>0 .05). CONCLUSION: The substitution of eight hours of ultrasound simulation training for live model scanning in a 24 hour training course did not enhance performance on written and image acquisition tests in an introductory ultrasound course for residents. This result suggests that ultrasound simulation technology used as a substitute for live model training on an hour-for-hour basis, did not improve learning outcomes. Further investigation into simulation as a total replacement for live model training will provide a clearer picture of the efficacy of ultrasound simulators in medical education.
Brazil* ; Education, Medical ; Internal Medicine ; Learning ; Point-of-Care Systems ; Simulation Training ; Ultrasonography*