Abstract:
OBJECTIVES:The lack of access to diagnostic imaging in resource-limited settings (RLSs) poses a worldwide problem. Advances in ultrasound (US) imaging technology bridge this gap, particularly when examinations are performed by physicians and integrated into the patient encounter, termed point-of-care ultrasound (POCUS). Because the number of physicians participating in short-term medical missions (STMMs) is increasing, the authors sought to characterize how the use of POCUS would affect care delivered as part of a 1-week outreach trip in rural Nicaragua. METHODS:In February 2017, as part of an ongoing collaboration among the University of South Carolina, the Medical University of South Carolina, and OneWorld Health, the authors conducted an observational prospective study of all of the patients who received a POCUS examination as part of standard clinical practice during an STMM to Sébaco, Nicaragua. The goal was to determine how often POCUS changed medical management. In addition, the number and types of scans performed were recorded to assess the most common reasons for POCUS use. RESULTS:More than 1100 patients were seen, and a total of 79 POCUS examinations were performed on 59 patients by 2 physicians with extensive POCUS training. Eighty percent of the patients were women, with an average age of 40.5 years (range 1.6-87 years). The use of US changed management for 35.6% of total patients examined (N = 21), divided among changes in diagnosis, pharmacotherapy, new referral, or referral not needed. The average time to perform a POCUS examination was 6.0 minutes. A wide range of POCUS examinations were performed, with lung, gallbladder, obstetric/gynecologic, and cardiac examinations performed most often. CONCLUSIONS:Incorporating POCUS by trained physicians in an RLS as part of an STMM was successful and often changed management. As interest in nonemergency and noncritical care POCUS increases and proliferation of low-cost, accurate, handheld US devices continues, it is probable that more physicians traveling to RLSs will use POCUS as part of STMMs, positively affecting patient care.
journal_name
South Med Jjournal_title
Southern medical journalauthors
Barron KR,Lai JC,MenkinSmith LP,Lee JS,Humphrey ME,Hall JWdoi
10.14423/SMJ.0000000000000826subject
Has Abstractpub_date
2018-07-01 00:00:00pages
434-438issue
7eissn
0038-4348issn
1541-8243pii
SMJ50555journal_volume
111pub_type
杂志文章abstract::Semiquantitative amniotic fluid volume (AFV) determination is a component of the fetal biophysical profile (BPP). To assess decreased AVF we did BPPs of 174 fetuses within 1 week of delivery. Two methods were used: measurement of the single largest vertical pocket (oligohydramnios = depth < 1 cm) and the four-quadrant...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199304000-00011
更新日期:1993-04-01 00:00:00
abstract::Preventive screening measures for low back pain are limited. Despite considerable evidence that anatomic narrowing of the lumbar spinal canal is a risk factor for specific back problems, difficulty in measuring the canal without unacceptable radiation exposure, cost, or discomfort has limited the assessment of its cli...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-198908000-00012
更新日期:1989-08-01 00:00:00
abstract::Implantation of automatic internal cardiac defibrillators (AICD) for management of arrhythmias necessitates the induction of ventricular fibrillation (VF) to test the device adequately. The profound hypotension associated with induced arrhythmia and subsequent circulatory arrest may result in cerebral ischemia. To cha...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199305000-00009
更新日期:1993-05-01 00:00:00
abstract::The comparative value of palpation, light percussion, and auscultatory percussion for detecting the liver below costal margin was studied in 45 normal subjects and 20 patients. The presence of the liver 2 cm or more below the costal margin was considered abnormal, since this organ was found no more than 1 cm below in ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199402000-00006
更新日期:1994-02-01 00:00:00
abstract::Extramural programs may be evaluated in terms of effectiveness in achieving their particular goals. The components of structure, process, and outcome are examined as related sets of program elements. Goals influence appropriate structure in organization, facilities, and manpower. Structure in turn influences process o...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197906000-00027
更新日期:1979-06-01 00:00:00
abstract:BACKGROUND:Many hospitalized anemic patients do not undergo appropriate evaluation. We hypothesized that specific clinical variables were likely to be important in triggering evaluation for iron deficiency anemia. METHODS:We prospectively identified 637 consecutive anemic patients without acute gastrointestinal bleedi...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e3181520392
更新日期:2007-10-01 00:00:00
abstract::Seven patients with diabetes of ten to 24 years' duration and renal insufficiency were treated with fluphenazine and amitriptyline in an attempt to control severe pain in the extremities. Six patients had relief of pain within five days of initiation of therapy. One patient had no pain relief despite mood alteration. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:1983-04-01 00:00:00
abstract::We found magnetic resonance imaging helpful in the localization of both an adrenal and an extra-adrenal pheochromocytoma, since these tumors produced a high-intensity "light bulb" image. MRI is an excellent method for localizing pheochromocytomas because it detects adrenal and extra-adrenal pheochromocytomas missed by...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198911000-00017
更新日期:1989-11-01 00:00:00
abstract:OBJECTIVES:Atrial fibrillation (AF) has been suggested as a cause for pulmonary embolism (PE). We aimed to explore the prevalence and clinical impact of AF in patients with PE. METHODS:Using the 2012-2014 National (Nationwide) Inpatient Sample database, we identified "adult patients with PE" as the principal discharge...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.14423/SMJ.0000000000001059
更新日期:2020-02-01 00:00:00
abstract::Patients with blunt hepatic injury can safely be managed nonoperatively if they show hemodynamic stability. Transcatheter arterial embolization (TAE) is a useful adjunct in the treatment of patients who show evidence of continued hemorrhage or who have pooling of contrast material on computed tomography (CT). In these...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:2000-07-01 00:00:00
abstract::An aberrant internal carotid artery (ICA) in the middle ear is rare. If unrecognized, it may lead to massive hemorrhage or other catastrophic results during even a minor surgical procedure of the tympanic membrane or middle ear. Recognition of this entity is particularly significant to the primary care or emergency de...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199412000-00014
更新日期:1994-12-01 00:00:00
abstract::Medical inpatients in inner-city hospitals have both potentially lead-related disorders and potential lead exposure. To see whether there is substantial unexpected lead intoxication in this population, we did a cross-sectional study of 117 consecutively admitted patients to a general medical ward of an inner-city univ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199605000-00003
更新日期:1996-05-01 00:00:00
abstract::Diabetic peripheral neuropathy affects 5 to 50% of people with diabetes in the United States. It is a progressive disorder that results in a gradual decrease in peripheral sensation and eventually complete loss of sensation. Patients with diabetic peripheral neuropathy are challenging to treat because of intolerable a...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.SMJ.0000060886.57804.2E
更新日期:2003-06-01 00:00:00
abstract::When involuntary psychiatric patients are treated on unlocked units, problems may arise as to resource expenditure and the ability to provide optimal psychiatric care. This study investigates the problem and possible solutions. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199306000-00016
更新日期:1993-06-01 00:00:00
abstract::Disorders of the foregut are an increasingly common cause of symptoms in Western populations. This review summarizes recent advances in the understanding and treatment of gastroesophageal reflux disease, dyspepsia and celiac disease. ...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/01.smj.0000242808.91797.3d
更新日期:2007-03-01 00:00:00
abstract::A case is reported of megaloblastic anemia resulting from folate deficiency in a vegetarian who had been taking oral contraceptives for eight years. A brief report of the pertinent literature is included, ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197502000-00029
更新日期:1975-02-01 00:00:00
abstract::Squamous cell carcinoma of the cervix is a common malignancy, but like other genital malignancies, it rarely metastasizes to the heart, even in advanced stages. This case illustrates several points, including the presentation of a cardiac metastasis mimicking ischemic cardiac disease on electrocardiogram. The diagnosi...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-199302000-00019
更新日期:1993-02-01 00:00:00
abstract::Renal mechanisms for metabolic acidosis in selective hypoaldosteronism were investigated in a patient with marked renal insufficiency. Studies demonstrated a distal hydrogen ion secretory defect. Control of elevated serum potassium levels did not normalize urinary acid excretion, but systemic acidosis was improved. Mi...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197811000-00023
更新日期:1978-11-01 00:00:00
abstract::Treatment of major abdominal vascular injuries is a challenge. Since 1973, 93 patients have been treated at our institution for 147 abdominal vascular injuries. The majority of these injuries (67%) resulted from penetrating trauma in young men between 21 and 30 years of age. Upon admission 72% of the patients were in ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198510000-00003
更新日期:1985-10-01 00:00:00
abstract:BACKGROUND:Postpneumonectomy electrocardiographic (ECG) changes have not been well-defined. METHODS:We reviewed the clinical data and the preoperative and postpneumonectomy ECGs of 15 patients who had pneumonectomy. RESULTS:All postpneumonectomy ECGs showed a higher heart rate and two (13%) showed diffuse ST elevatio...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:2000-10-01 00:00:00
abstract::A 62-year-old woman developed a fatal Aeromonas hydrophila infection of the skin after dropping a crab trap on her leg. The area surrounding the punctures was erythematous and had several flaccid bullae. A biopsy specimen of the involved skin showed necrosis and suppuration in the dermis and subcutaneous fat. The A hy...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197806000-00037
更新日期:1978-06-01 00:00:00
abstract::A cross-sectional survey of a total semirural biracial population of children was conducted to determine the prevalence and types of cardiac disease. Of 4,074 children examined, 146 were thought to have significant cardiac murmurs. One hundred thirteen of these participated in a follow-up study in which they received ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198210000-00006
更新日期:1982-10-01 00:00:00
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journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198708090-00021
更新日期:1987-09-01 00:00:00
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journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198110000-00013
更新日期:1981-10-01 00:00:00
abstract::Appendicovesical fistula is an uncommon condition usually occurring in boys and young men and associated with chronic urinary tract infection. Diagnosis is based on cystoscopic findings that may be confirmed by a retrograde study. Treatment by appendectomy is usually successful. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198004000-00037
更新日期:1980-04-01 00:00:00
abstract::Cirrhosis affects millions of people around the world and is associated with increased morbidity and mortality. Spontaneous bacterial peritonitis (SBP) is a common complication of liver disease with cirrhosis and accounts for up to 30% of infections in patients with cirrhosis. Patients with a history of SBP and those ...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.14423/SMJ.0000000000000887
更新日期:2018-11-01 00:00:00
abstract::We describe a patient with pseudotumor cerebri for which a lumboperitoneal (LP) shunt was placed. After a pseudomeningocele was noted at the lumbar incision site, an LP shunt revision was done, at which time migration of the catheter into the thecal sac was noted. Three months later, radiologic studies revealed crania...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199606000-00019
更新日期:1996-06-01 00:00:00
abstract::Chest pain is a frequent patient complaint that requires a careful history and physical examination to determine its cause. Cardiac and esophageal causes of chest pain are common, but musculoskeletal disorders such as Tietze's syndrome, chest wall pain syndromes, fibrositis, inflammatory arthritic conditions, cervical...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-198801000-00014
更新日期:1988-01-01 00:00:00
abstract::Of 72 patients with chronic myelogenous leukemia (CML), 37 were Ph1 positive, eight were negative, and 27 were not evaluated for the Ph1 chromosome. Of the 37 patients positive for Ph1, 31 had adequate evaluation. These 31 patients were reviewed for survival with reference to spleen size. Seventeen patients with splee...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197906000-00003
更新日期:1979-06-01 00:00:00
abstract::A group of 251 randomly selected physicians completed a survey designed to study their attitudes toward, knowledge about, and use of pneumococcal vaccine. Eighty-five percent of respondents believed the vaccine had been proven effective. For the use of the vaccine, respondents supported broad indications, including ch...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198404000-00010
更新日期:1984-04-01 00:00:00