ABSTRACT
Background: In low- and middle-income countries (LMICs) where echocardiography experts are in short supply, training non-cardiologists to perform Focused Cardiac Ultrasound (FoCUS) could minimise diagnostic delays in time-critical emergencies. Despite advocacy for FoCUS training however, opportunities in LMICs are limited, and the impact of existing curricula uncertain. The aim of this study was to assess the impact of FoCUS training based on the Focus Assessed Transthoracic Echocardiography (FATE) curriculum. Our primary objective was to assess knowledge gain. Secondary objectives were to evaluate novice FoCUS image quality, assess inter-rater agree-ment between expert and novice FoCUS and identify barriers to the establishment of a FoCUS training pro-gramme locally. Methods: This was a pre-post quasi-experimental study at a tertiary hospital in Nairobi, Kenya. Twelve novices without prior echocardiography training underwent FATE training, and their knowledge and skills were as-sessed. Pre- and post-test scores were compared using the Wilcoxon signed-rank test to establish whether the median of the difference was different than zero. Inter-rater agreement between expert and novice scans was assessed, with a Cohen's kappa > 0.6 indicative of good inter-rater agreement. Results: Knowledge gain was 37.7%, with a statistically significant difference between pre-and post-test scores (z = 2.934, p = 0.001). Specificity of novice FoCUS was higher than sensitivity, with substantial agreement between novice and expert scans for most FoCUS target conditions. Overall, 65.4% of novice images were of poor quality. Post-workshop supervised practice was limited due to scheduling difficulties. Conclusions: Although knowledge gain is high following a brief training in FoCUS, image quality is poor and sensitivity low without adequate supervised practice. Substantial agreement between novice and expert scans occurs even with insufficient practice when the prevalence of pathology is low. Supervised FoCUS practice is challenging to achieve in a real-world setting in LMICs, undermining the effectiveness of training initiatives
Subject(s)
Capacity Building , Cardiac Catheters , Kenya , Poverty , Ultrasonography/educationABSTRACT
Background: Cardiovascular research publications seem to be increasing in Latin America overall. Objective: To analyze trends in cardiovascular publications and their citations from countries in Latin America between 1999 and 2008, and to compare them with those from the rest of the countries. Methods: We retrieved references of cardiovascular publications between 1999 and 2008 and their five-year post-publication citations from the Web of Knowledge database. For countries in Latin America, we calculated the total number of publications and their citation indices (total citations divided by number of publications) by year. We analyzed trends on publications and citation indices over time using Poisson regression models. The analysis was repeated for Latin America as a region, and compared with that for the rest of the countries grouped according to economic development. Results: Brazil (n = 6,132) had the highest number of publications in1999-2008, followed by Argentina (n = 1,686), Mexico (n = 1,368) and Chile (n = 874). Most countries showed an increase in publications over time, leaded by Guatemala (36.5% annually [95%CI: 16.7%-59.7%]), Colombia (22.1% [16.3%-28.2%]), Costa Rica (18.1% [8.1%-28.9%]) and Brazil (17.9% [16.9%-19.1%]). However, trends on citation indices varied widely (from -33.8% to 28.4%). From 1999 to 2008, cardiovascular publications of Latin America increased by 12.9% (12.1%-13.5%) annually. However, the citation indices of Latin America increased 1.5% (1.3%-1.7%) annually, a lower increase than those of all other country groups analyzed. Conclusions: Although the number of cardiovascular publications of Latin America increased from 1999 to 2008, trends on citation indices suggest they may have had a relatively low impact on the research field, stressing the importance of considering quality and dissemination on local research policies. .
Fundamento: As publicações sobre pesquisa cardiovascular parecem estar crescendo na América Latina em geral. Objetivo: Analisar as tendências nas publicações cardiovasculares e suas citações de países na América Latina entre 1999 e 2008, e compará-las àquelas dos demais países. Métodos: Recuperamos, a partir da base de dados Web of Knowledge, as referências de publicações cardiovasculares entre 1999 e 2008 e as suas citações cinco anos após publicação. Para os países da América Latina, calculamos o número total de publicações e seus índices de citação (número total de citações dividido pelo número de publicações) por ano. Analisamos as tendências das publicações e dos índices de citação ao longo do tempo usando modelos de regressão de Poisson. A análise foi repetida para a América Latina como região e comparada àquela para os demais países agrupados de acordo com o desenvolvimento econômico. Resultados: O Brasil (n = 6.132) apresentou o mais alto número de publicações no período 1999-2008, seguindo-se Argentina (n = 1.686), México (n = 1.368) e Chile (n = 874). A maioria dos países apresentou elevação do número de publicações ao longo do tempo, principalmente Guatemala (36,5% anual [IC 95%: 16,7%-59,7%]), Colômbia (22,1% [16,3%-28,2%]), Costa Rica (18,1% [8,1%-28,9%]) e Brasil (17,9% [16,9%-19,1%]). No entanto, as tendências dos índices de citação variaram muito, de -33,8% a 28,4%. De 1999 a 2008, as publicações cardiovasculares na América Latina aumentaram em 12,9% (12,1%-13,5%) por ano. Entretanto, os índices de citação da América Latina aumentaram 1,5% (1,3%-1,7%) por ano, um aumento menor do que aqueles dos demais grupos de países analisados. Conclusões: Embora o número de publicações cardiovasculares da América Latina tenha aumentado de 1999 a 2008, tendências nos índices de citação sugerem que elas possam ter tido um impacto relativamente baixo na área de pesquisa, reforçando a importância de se considerar a qualidade e a disseminação ...