The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature.

OBJECTIVES: To review the scientific literature pertaining to the use of hand-carried and hand-held ultrasound devices in low- and middle-income countries (LMIC), with a focus on clinical applications, geographical areas of use, the impact on patient management and technical features of the devices used. METHODS: The electronic databases PubMed and Google Scholar were searched. No language or date restrictions were applied. Case reports and original research describing the use of hand-carried ultrasound devices in LMIC were included if agreed upon as relevant by two-reviewer consensus based on our predefined research questions. RESULTS: A total of 644 articles were found and screened, and 36 manuscripts were included for final review. Twenty-seven studies were original research articles, and nine were case reports. Several reports describe the successful diagnosis and management of difficult, often life-threatening conditions, using hand-carried and hand-held ultrasound. These portable ultrasound devices have also been studied for cardiac screening exams, as well as a rapid triage tool in rural areas and after natural disaster. Most applications focus on obstetrical and abdominal complaints. Portable ultrasound may have an impact on clinical management in up to 70% of all cases. However, no randomised controlled trials have evaluated the impact of ultrasound-guided diagnosis and treatment in resource-constrained settings. The exclusion of articles published in journals not listed in the large databases may have biased our results. Our findings are limited by the lack of higher quality evidence (e.g. controlled trials). CONCLUSIONS: Hand-carried and hand-held ultrasound is successfully being used to triage, diagnose and treat patients with a variety of complaints in LMIC. However, the quality of the current evidence is low. There is an urgent need to perform larger clinical trials assessing the impact of hand-carried ultrasound in LMIC.

Implementation of a bag medication reconciliation initiative to decrease posthospitalization medication discrepancies.

Medication discrepancies occur in 70% of hospital patients, especially during discharge. In community settings, bag medication reconciliation events have demonstrated effectiveness in evaluating current medication use and identifying medication discrepancies. A bag medication reconciliation process was implemented in the hospital setting to decrease medication discrepancies by encouraging evaluation of medication adherence, side effects, and monitoring at posthospitalization follow-up. After implementation, a 7% decrease in reportable errors was noted.

Hemophagocytic lymphohistiocytosis (HLH) presenting as fever of unknown origin and acute liver failure.

A 51-year-old previously healthy woman presenting with two-weeks of fever, flu-like symptoms, jaundice, and abdominal pain was found to have pancytopenia, transaminitis, and significantly elevated ferritin in the setting of an Epstein-Barr Virus (EBV) infection. Bone marrow biopsy revealed phagocytic macrophages consistent with findings of hemophagocytic lymphohistiocytosis (HLH). Given bone marrow findings and that the patient had five of the eight clinical criteria supporting the diagnosis of HLH, chemotherapy was initiated as per the HLH-94 protocol with initial improvement in patient's symptoms and overall functional status. This case demonstrates a classic presentation of HLH and displays the importance of correct diagnosis and prompt treatment.

Implementing a night-shift clinical nurse specialist.

Night-shift nurses receive fewer educational opportunities and less administrative support than do day-shift staff, tend to be newer, with less experience and fewer resources, and experience greater turnover rates, stress, and procedural errors. In an attempt to bridge the gap between day- and night-shift nursing, a night-shift clinical nurse specialist (CNS) position was created in a midsized, community teaching hospital. The goal was to provide an advanced practice presence to improve patient outcomes, communication, education, and cost-effectiveness. The night-shift CNS participated in nursing education and skill certifications, communicated new procedures and information, and created a communication committee specifically for night-shift nurses. Through regular rounding and on-call notification, the CNS was available to every area of the hospital for consultation and clinical assistance and assisted with rapid responses, codes, and traumas. Providing education during night shift reduced overtime costs and increased morale, positively affecting turnover rates. The night-shift CNS position has improved morale and equalized support for night-shift nurses. More research, most notably in specific night-shift metrics, is necessary, and with the implementation of the role in additional facilities, more can be understood about improving patient care and nursing staff satisfaction during night shift.