The Role of Telehealth in Ultrasound Training for Remote Learners: A Systematic Review.

Introduction: Remote learners and educators face geographic, professional, and personal barriers that affect their access to quality ultrasound education. The integration of telehealth in ultrasound education enables learners performing ultrasound to receive real-time instruction from an educator at a distant or remote site. However, to date, there has been poor understanding of the efficacy, benefits, shortcomings, and economic impact of telehealth education in comparison to in-person ultrasound training. The aim of this research was to assess current literature on telehealth in ultrasound education and hands-on training, its outcomes and impact, and requirements for future development. Methods: This review examined international literature on telehealth in ultrasound training. The primary author and second investigator were involved in the research and reached consensus on the eligibility criteria, search strategy, included articles, data extraction, and quality assessment. Results: A total of 23 studies were obtained from Medline, Emcare and Scopus. Key themes identified: Most studies saw an equivalent improvement in knowledge and skills through pre and postassessments in both in-person and telehealth sessions. Generally, learners felt comfortable performing ultrasound guided by a remote educator and felt their skills had been advanced across all studies. Educators reported positive feedback, however compared with learners, educators expressed less satisfaction with the telehealth session. Conclusions: This study demonstrated the feasibility of telehealth in ultrasound training for remote learners with little to no experience. Quality studies with comparable outcomes are needed to ascertain the safe and effective application of telehealth in ultrasound training.

Antenatal ultrasound needs-analysis survey of Australian rural/remote healthcare clinicians: recommendations for improved service quality and access.

BACKGROUND: Ultrasound is the primary diagnostic tool in pregnancy, capable of identifying high-risk pregnancies and life-threatening conditions, allowing for appropriate management to prevent maternal and fetal morbidity and mortality. Women and babies from rural and remote Australia and low-resource areas worldwide experience poorer health outcomes and barriers to accessing antenatal care and imaging services. Healthcare clinicians working in these regions face significant challenges practising with limited resources and accessing training opportunities. OBJECTIVE: To perform an exploratory needs-analysis survey investigating the availability, accessibility and use of antenatal ultrasound in rural Australia, exploring rural clinicians' interest in and access to ultrasound training opportunities. METHODS: The survey tool for this cross-sectional study was designed and distributed as an anonymous online questionnaire targeting healthcare clinicians (doctors, nurses, midwives, clinic managers, Aboriginal healthcare workers) providing antenatal care in rural regions. Descriptive analysis was applied to quantitative data and thematic analysis was used to explore qualitative components. RESULTS: A total of 114 valid survey responses were analysed. Overall, 39% (43/111) reported ultrasound was not used when providing antenatal care to patients at their clinic, stating 'Lack of ultrasound equipment (73%,29/40) and inaccessibility of training opportunities (47%,19/40) as the main reasons. For those with ultrasound (61%,68/111), estimating due date (89%,57/64) was the main use, and limited training/skills to operate the equipment (59%,38/64) and inaccessibility/distance of training opportunities (45%,29/64) were the most commonly reported barriers. Clinicians described a lack of childcare options (73%,74/102), long distances to reach ultrasound services (64%,65/102), appointment (59%,60/102) and transport availability/times (46%,47/102) as the main obstacles to patient access. Increased attendance, compliance with care directives, parental bonding and improved lifestyle choices were described by respondents as positive outcomes of antenatal ultrasound use. CONCLUSIONS: Future efforts to combat inequitable service access must adopt a coordinated approach to meet the needs of pregnant women in low-resource settings. Providing portable ultrasound equipment, training in antenatal Point-of-Care ultrasound (PoCUS) with ongoing support/mentoring and accreditation of health professionals could strengthen rural workforce capacity. This, along with addressing the complex economic, environmental and socio-cultural barriers faced by patients, could improve service access and pregnancy outcomes in rural and remote communities.

Ultrasound Characteristics and Scanning Techniques of Uterosacral Ligaments for the Diagnosis of Endometriosis: A Systematic Review.

Endometriosis is a common and painful gynaecological condition that takes an average of 6.4years to diagnose. While laparoscopic surgery is the recommend gold standard in diagnosis of endometriosis, transvaginal ultrasound (TVS) is able to assist surgeons in the planning and management of patients, especially when there is limited visualisation in the posterior compartment. Uterosacral ligaments (USL) are located in the posterior compartment and are one of the first and most common places that endometriosis deposits, The International Deep Endometriosis Analysis (IDEA) group consensus, which are the current guidelines for DE imaging, recommends a thorough ultrasound assessment to identify endometriotic disease. This includes an assessment of anatomic structures in the posterior compartment including the USLs. However, IDEA does not explicitly articulate specifics of USL imaging and measurements on ultrasound. The primary aim of this review is to determine is to identify ultrasound techniques and characteristics of USLs in the diagnosis of deep infiltrative endometriosis (DE). The secondary aim is to describe and summarise these findings into normal and pathological findings. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A population, interventions, comparator, and outcome framework was used to define a search strategy. Articles were screened using Covidence review management system, and data was extracted by two authors using a standardised and piolet-tested form. Quality assessment was conducted using the Critical Appraisal Skills Programme (CASP). Medline, Embase and Scopus and Google Scholar were searched yielding 250 articles, with 22 being included in the review. Analysis of the data demonstrated inconsistent reporting of ultrasound techniques and characteristics of USLs. Most (20/22) papers described abnormal criteria of USLs, only 5/22 papers determined what the normal USL appearance is or what techniques (11/22) were applied. Even though reporting was heterogeneous, there was a high level of tertiary centre participation with gynaecological experienced operators, therefore was a high level of agreement. Through review of the current literature, this study has investigated ultrasound techniques and characteristics of USLs for the diagnosis of DE. All papers included in this review reported presence of pathological sonographic findings of the USLs when DE was presented therefore it is recommended that USL examination become a part of TVS exams when DE is clinically suspected. This study also demonstrated that there was lack of data and no agreement when it comes to measuring USLs with DE. Even so, the current evidence demonstrates that scanning the USLs, and locating, identifying, and describing USL thickening and endometriotic nodules in the various locations using the described techniques and characteristics in this review has clinical value in early diagnosis.

Establishing diagnostic reference levels for pediatric fluoroscopic examinations in a tertiary hospital.

BACKGROUND: Diagnostic reference levels (DRLs) identify unusually high patient radiation exposures and are required for dose optimisation. DRLs for pediatric fluoroscopic examinations are not widely determined in Australia. OBJECTIVE: Our objectives were to establish DRLs for pediatric fluoroscopic examinations in a South Australian tertiary hospital and compare these to previously published data and to explore relationships between patient dose area product (DAP), age and fluoroscopy times. MATERIALS AND METHODS: Dose data from 365 pediatric patients undergoing 5 fluoroscopic examinations were retrospectively collected for a 3-year period commencing January 2018 to develop local DRLs. Relationships between DAP, age and fluoroscopy time were explored using scatterplots, Spearman's correlation, and regression analyses. RESULTS: Local DRLs were significantly lower than data published previously, possibly reflecting technological and procedural advancements. Each 1-year increase in patient age was associated with a 0.77 µGy·m2 increase in DAP for barium meal and follow-through studies (95% confidence interval [CI]=0.055, 1.48) (P=0.04), and a 1.37 µGy·m2 increase in DAP for barium swallow studies (95% CI=0.61, 2.12) (P<0.001). A low correlation was demonstrated between DAP and fluoroscopy time for micturating cystourethrography studies (r=0.35, 95% CI=0.15, 0.51, P<0.001) and barium meal and follow-through studies (r=0.37, 95% CI= -0.011, 0.65, P=0.05). Age and fluoroscopy time were not significantly related. CONCLUSION: This study provides updated Australian pediatric fluoroscopic DRLs, with the intention of promoting a national database for benchmarking pediatric doses. The local DRLs can be used for dose comparisons and optimisation between facilities.

Evaluation of antenatal point-of-care ultrasound training workshops for rural/remote healthcare clinicians: a prospective single cohort study.

BACKGROUND: There is limited access to life-saving antenatal ultrasound in low-resource rural and remote settings worldwide, including Australia, mainly due to shortages in skilled staff. Point-of-care ultrasound (PoCUS) offers a viable solution to this service deficit, however, rural clinicians face many barriers accessing training and professional development critical to advancing their clinical practice. Standards for PoCUS training and competency assessment are unclear. Regulation is lacking globally, allowing untrained and inexperienced clinicians to practice PoCUS clinically. METHODS: This prospective single cohort study aimed to evaluate antenatal PoCUS training workshops for General Practitioners (GPs) and Midwives/Nurses (M/Ns) from rural/remote Australia, assessing the impact of the training on trainees' knowledge, confidence and translation of PoCUS into clinical practice. Two-day antenatal ultrasound workshops were delivered at the University of South Australia (UniSA) in 2018 and 2019 to 41 rural/remote clinicians . The training was designed and evaluated using the New world Kirkpatrick Evaluation Framework. Sixteen GPs and 25 M/Ns with mixed prior ultrasound experience were funded to attend. The course consisted of lectures interspaced with hands-on training sessions using high-fidelity simulators and live pregnant models. Pre- and post-knowledge assessments were performed. Post-workshop evaluation and follow-up surveys (3- and 6-month post-training) assessed the workshops and changes to trainees' clinical practice. A 2-day follow-up training session was conducted 12 months after the workshops for 9 trainees. RESULTS: Pre/post knowledge testing demonstrated a 22% mean score improvement (95% CI 17.1 to 27.8, P < 0.0001). At 6 months, 62% of trainees were performing PoCUS that had assisted in patient management and clinical diagnosis, and 46% reported earlier diagnosis and changes to patient management. 74% of trainees had increased scanning frequency and 93% reported improved scanning confidence. CONCLUSION: This study demonstrated intensive 2-day workshops can equip clinicians with valuable antenatal PoCUS skills, offering a viable solution to assist in the assessment and management of pregnant women in the rural/resource-poor setting where access to ultrasound services is limited or non-existent. Geographical isolation and lack of onsite specialist supervision poses an ongoing challenge to the continuing professional development of remote trainees and the implementation of PoCUS.

Current Status of Transvaginal Ultrasound Accuracy in the Diagnosis of Deep Infiltrating Endometriosis Before Surgery: A Systematic Review of the Literature.

Endometriosis is a common gynecologic condition affecting as many as 1 per 10 women. Transvaginal ultrasound (TVUS) has become a frontline tool in the diagnosis of deep infiltrating endometriosis (DIE) before surgery. The primary aim of this review was to determine the accuracy of TVUS for DIE. The secondary aim was to determine accuracy specifically when a sonographer performed the TVUS examination. A systematic review was performed, searching literature by following a population, intervention, comparator, and outcome outline. MEDLINE, Embase, Emcare, and Google Scholar were searched in July 2018 and in November 2019. Including "sonographer" in the search terms yielded no results, so our terms were expanded. Two hundred and four articles were returned from the searches, and 35 were ultimately included in the final review. Analysis of the returned articles revealed the TVUS is a valuable diagnostic tool for DIE before surgery. Sensitivities ranged from 78.5% to 85.3%, specificities from 46.1% to 92.5%, and accuracies from 75.7% to 97%. Most authors reported site-specific sensitivities and specificities, which varied greatly between locations. Site-specific sensitivities ranged from 10% to 88.9% (uterosacral ligaments), 20% to 100% (bladder), 33.3% to 98.1% (rectosigmoid colon), and 31% to 98.7% (pouch of Douglas). Site-specific specificities ranged from 75% to 99.6% (uterosacral ligaments), 96.4% to 100% (bladder), 86% to 100% (rectosigmoid colon), and 90% to 100% (pouch of Douglas). Transvaginal ultrasound is an accurate tool in the diagnosis of DIE; however, limited data exist as to whether this technique is accurate when performed by sonographers. More evidence surrounding the reliability between operators is also needed.

Effect of Behavioral Activation for Women with Postnatal Depression: A Systematic Review and Meta-Analysis.

Evidence shows that behavioral activation (BA), a simple form of psychological therapy, is as effective as the more complex psychological therapy-cognitive behavioral therapy (CBT)-in treating general depression. However, it remains unclear whether BA when compared with treatment-as-usual (TAU) has greater contributions in reducing postnatal depression. This systematic review compared the effect of BA versus TAU in reducing depression symptoms among postnatal women. Five databases (MEDLINE, Embase, Emcare, Cochrane Library, and PsycINFO) were searched. Risk of bias was assessed using the Cochrane Collaboration's 'risk-of-bias 2 tool'. A random-effects meta-analysis was conducted to examine the effect of BA on postnatal depression. Of 2844 initial studies, only two randomized control trials (RCTs) met the inclusion criteria. The overall quality of evidence of these two RCTs was low. When compared to TAU, meta-analysis showed that BA was associated with reduced depression symptoms in postnatal women (standard mean difference -0.56; 95% confidence interval -0.76 to -0.37). This review suggests that BA might be more effective than TAU for alleviating postnatal depression. However, due to concerns about evidence quality, these findings should be interpreted cautiously.

Australasian sonographers' knowledge, awareness, and attitudes towards the international evidence-based guidelines for the diagnosis of polycystic ovarian syndrome.

Introduction/Purpose: Many guidelines have been utilised to diagnose polycystic ovarian syndrome (PCOS). The most recent are the International Evidence Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018 (2018 IEBG). This study aimed to assess the awareness, knowledge, and attitudes of Australasian sonographers' regarding these guidelines. Methods: An online cross-sectional survey was disseminated to sonographers. Qualitative and quantitative questions were asked around awareness, knowledge, and attitudes towards the 2018 IEBG. Statistical and thematic analyses of the results were performed. Results: Ninety responses were included in the final analysis. Fifty-two percent (52.2%) of participants were aware of the 2018 IEBG but only 31.1% used it in their workplaces. Fifty-eight percent (57.9%) of participants correctly identified the sonographic features that suggest PCOS, and 3.5% correctly identified all minimum recommended inclusions for reporting a gynaecological ultrasound for PCOS. Prior to being supplied the 2018 IEBG, 15.8% of participants correctly answered clinical scenario-based knowledge questions, which increased to 29.4% correctly after being supplied the guideline; however, this difference was not statistically significant. There were no statistically significant associations between demographics and knowledge of the 2018 IEBG. Discussion: Several areas of confusion surrounding wording and interpretation of the 2018 IEBG were highlighted. Consideration should be given to barriers of implementation and strategies to overcome these. Conclusion: More education surrounding the sonographic diagnosis of PCOS and the 2018 IEBG is needed. Scanning protocols used amongst sonographers varied, suggesting that inconsistency in sonographic diagnosis may exist. Future reviews of the 2018 IEBG should focus on reducing ambiguity in wording, which may be responsible for some of the varied interpretation of these guidelines.

What is the accuracy of transvaginal ultrasound for endometriosis mapping prior to surgery when performed by a sonographer within an outpatient women's imaging centre?

INTRODUCTION: This study aimed to assess the accuracy of transvaginal ultrasound (TVUS) for the mapping of endometriosis before surgery when performed by sonographers in an outpatient women's imaging centre. METHODS: A prospective longitudinal cohort study was performed. The study group comprised of 201 women who underwent a comprehensive TVUS assessment, performed by a sonographer. Laparoscopy was performed as the reference standard. Complete TVUS and surgical data were available for 53 women who were included in the final analysis. RESULTS: Endometriosis was confirmed at a surgery in 50/53 (94.3%) participants, with 25/53 (47.2%) having deep endometriosis (DE) nodules and/or endometriomas present. TVUS for mapping of DE had an overall sensitivity of 84.0%, specificity of 89.3%, PPV of 87.5%, NPV of 86.2%, LR+ of 7.85, LR- of 0.18, and accuracy of 86.8% (P < 0.001). Ovarian immobility had poor sensitivity for detecting localised superficial endometriosis, DE, adhesions, and/or endometriomas (Left = 61.9% and right = 13.3%) but high specificities (left = 87.5% and right = 94.7%). Site-specific tenderness had low sensitivities and moderate specificities for the same. All soft markers of endometriosis failed to reach statistical significance except for left ovarian immobility (P = <0.001). CONCLUSION: Sonographers well experienced in obstetric and gynaecological imaging, working in an outpatient women's imaging setting can accurately map DE; however, the performance of soft markers for detection of SE was poor.

Evaluation of antenatal Point-of-Care Ultrasound (PoCUS) training: a systematic review.

INTRODUCTION: There is limited access to life-saving antenatal ultrasound in rural and low-resource settings largely due to shortages in skilled staff. Studies have shown healthcare practitioners can be upskilled in PoCUS through focused training, offering a viable solution to this deficit. However, standards for training and competency assessment are unclear and regulation surrounding practice is lacking. We aimed to review published literature examining antenatal PoCUS training programs, comparing teaching approaches and study methodologies. METHODS: A search of electronic databases EMBASE, MEDLINE and Google Scholar was conducted. Original research articles evaluating antenatal PoCUS training of healthcare professionals worldwide were identified for analysis. Articles with limited detail on the PoCUS training intervention and those describing comprehensive diagnostic training programs were excluded. Evaluations were compared against the Kirkpatrick Evaluation Framework (KEF). RESULTS: Twenty-seven studies were included from an initial search result of 484 articles. There was considerable heterogeneity between the PoCUS training programs described. Course duration ranged from 3 hours to 2 years, with 11 of the 27 studies delivering obstetric-exclusive content. 44% trained multidisciplinary groups of health professionals. Long-term follow-up training and skills assessments were lacking in over half of the reviewed studies. Study quality and reporting detail varied, but overall beneficial outcomes were reported with 3/4s of the studies reaching upper KEF levels 3 and 4. CONCLUSION: PoCUS performed by upskilled healthcare professionals offers an attractive solution to the problem of inequitable access to antenatal ultrasound. A review of available literature highlighted a paucity of comparable high-quality studies needed to establish a stronger evidence base for antenatal PoCUS, and a need to standardise training and competency assessment. This review may inform educators, researchers and policy-makers on existing training formats and methodologies to assist in establishing best practice antenatal PoCUS training methods for safe service delivery by remote healthcare professionals.

Can We Compare the Health-Related Quality of Life of Childhood Cancer Survivors Following Photon and Proton Radiation Therapy? A Systematic Review.

Paediatric cancer patients have a risk of late side effects after curative treatment. Proton radiation therapy (PRT) has the potential to reduce the incidence and severity of toxicities produced by conventional photon radiation therapy (XRT), which may improve the health-related quality of life (HRQoL) in children. This systematic review aimed to identify the evidence of HRQoL outcomes in childhood cancer survivors following XRT and PRT. Medline, Embase, and Scopus were systematically searched. Thirty studies were analysed, which described outcomes of 1986 childhood cancer survivors. Most studies (n = 24) described outcomes for children with a central nervous system (CNS) tumour, four studies reported outcomes for children with a non-CNS tumour, and two studies combined CNS and non-CNS diagnoses within a single cohort. No studies analysed routine HRQoL collection during paediatric radiation oncology clinical practice. There is insufficient quality evidence to compare HRQoL outcomes between XRT and PRT. Therefore, the current state of the literature does not conclude that PRT produces superior HRQoL outcomes for childhood cancer survivors. Standardised clinical implementation of HRQoL assessment using patient-reported outcomes is recommended to contribute to improvements in clinical care whilst assisting the progression of knowledge comparing XRT and PRT.

How long does a transvaginal ultrasound examination for endometriosis take in comparison to a routine transvaginal ultrasound examination?

INTRODUCTION: This study aimed to determine the additional time needed to perform an endometriosis transvaginal ultrasound (eTVUS) compared to routine transvaginal ultrasound (rTVUS). METHODS: A retrospective case-control study was performed. The study group included 199 eTVUS performed between September 2019 and September 2020. The control group comprised 105 consecutive rTVUS studies performed in the same time period. The time stamps on the ultrasound images of all cases in both groups were reviewed to determine the time taken to perform each study. Mean, median, minimum and maximum scan times for both groups were calculated as was percentage difference between scan times. A two-tailed, unpaired t-test of the normalised data and a Mann-Whitney U test assessing time difference of scans between two groups were performed with P value <0.05 considered statistically significant. RESULTS: Performing eTVUS took significantly longer than rTVUS with increases in the mean (8.4 vs 13.8 min, 64%), median (7 vs 12 min, 71%), minimum (4 vs 7 min, 75%) and maximum (19 vs 42 min, 121%) scan times. The Mann-Whitney U test indicated a statistically significant difference in the median scan times (5.0, CI 4.0-6.0), P < 0.001. An independent t-test of the normalised data revealed a significantly larger mean scan time for eTVUS than rTVUS, Mean = 9.05 95%CI [13.17-4.94], t(302) = 4.327, P < 0.001. R 2 = 0.583. CONCLUSION: Endometriosis transvaginal ultrasound added an average 5.4 min to rTVUS, which is statistically significant. For ultrasound departments wanting to offer this technique, doubling the scan time allocated to perform a transvaginal ultrasound (TVUS) is suggested.

Rural health workers' perspectives and experience with an online educational program in behavioural activation: A thematic analysis.

Cognitive behavioural therapy (CBT) is an effective treatment for depression. There are established education programmes which prepare specialist mental health workers to practice CBT. CBT is a complex treatment requiring intensive preparation and clinical skill to deliver. An alternative and simpler psychological treatment, behavioural activation (BA), may be as effective as CBT. An advantage of BA over CBT is that you do not need to be a specialist mental health worker nor require lots of training to deliver it. The relative simplicity of BA and the brief education required for workers to deliver it may increase access to psychological treatments for depression. In 2020, we developed an online educational programme in BA targeting non-specialist healthcare workers. In this paper, we wanted to understand healthcare workers' perceptions and experiences of completing a professional certificate programme which prepares them to deliver BA for people living with depression. We report the feedback from seven non-specialist mental health workers who completed the online education programme in BA. Twelve workers were invited to enrol on the programme, of which four declined. All but one of the eight participants lived and worked in rural South Australia. A thematic analysis of the interview data identified three themes: Course was simple to follow, Ease of integration into clinical practice and Ongoing support and supervision. The overall meta-theme was 'Easy to train and easy to apply'. Participants reported that the online training prepared them to practice BA and they were able to apply the skills in their clinical practice. Future work needs to examine if online training for healthcare workers in BA translates to clinical outcomes for people living with depression.

A Pilot Study to Examine the Effect of an Educational Poster on the Knowledge and Practices of Lateral Elbow Radiograph Repositioning in Radiographers.

AIM: This pilot study aimed to evaluate the knowledge and practices of South Australian radiographers regarding lateral elbow repositioning and to determine whether an educational poster could improve repositioning knowledge. METHOD: The study was undertaken in four stages. Stage one involved the development of a survey to explore radiographer knowledge and practices surrounding lateral elbow repositioning. Stage two involved the development of an educational poster. Stage three was a pilot validity study. Three participants (n = 3) were involved in testing the validity and test-retest reliability of the survey and the poster. Stage four was the interventional study which involved the distribution of surveys to two radiography departments in South Australia on two occasions, before and after the distribution of the poster. Six complete data sets were analysed. RESULTS: The pilot validity study ensured the test-retest reliability of the survey was strong (P = .629). It was determined that an educational poster made no significant difference to the knowledge of lateral elbow radiograph repositioning among radiographers (P = .253). It was indicated that this result was not due to familiarity with the presurvey questions (P = .171). Thematic analysis of the open discussion questions found that most participants found the poster helpful but did not consider repositioning to be difficult. The introduction of the poster did not increase image repeat rate and the poster was used moderately over the study length. CONCLUSION: As this study was unable to determine whether a poster could improve the knowledge and practices of lateral elbow repositioning among radiographers, further research is needed.

Review of Health Economics of Point-of-Care Testing Worldwide and Its Efficacy of Implementation in the Primary Health Care Setting in Remote Australia.

There are important differences concerning health outcomes between the Australian population living in rural/remote regions and the urban population. Health care provision in remote areas, particularly in regions with a low number of inhabitants, is not without challenges. Aboriginal, rural and remote communities are therefore affected, as they face various obstacles in accessing health services, owing to geographical settings, difficulties in transportation to nearby hospitals, limited or inexistent local qualified personnel. The implementation of point-of-care testing could be a plausible solution to these challenges, as various point-of-care services that have been successfully put into action worldwide indicate towards positive clinical outcomes. Point-of-care units have a real potential in reducing morbidity and mortality in all population groups. This article aims to review the published literature on point-of-care testing around the world, with a focus on health economics and the feasibility of its implementation in Australian rural and remote regions.

Exploring the availability and impact of antenatal point-of-care ultrasound services in rural and remote communities: A scoping review.

BACKGROUND: There are global disparities in the provision of maternal health care, with women from rural communities and under-resourced countries expecting poorer access to healthcare services. This potentially compounds the existing higher burden of maternal and neonatal morbidity within these populations. In this setting, point-of-care ultrasound (PoCUS) has the potential to improve outcomes while mitigating challenges and barriers associated with the introduction of new medical technology. OBJECTIVES: To explore the availability and impact of PoCUS use for antenatal care (ANC) in under-resourced settings. METHODS: Medline, Embase and Scopus were searched with no year limit. Studies were included if the participants were pregnant women undergoing ANC in a rural setting or developing country and if the intervention was PoCUS use or training. RESULTS: A total of 3863 unique articles were identified, with 17 meeting the inclusion criteria. Studies originated from Africa, Asia, Central America and Australia. All studies reported that POCUS use for ANC produced positive outcomes. PoCUS introduction into routine ANC resulted in higher antenatal attendance and reduced maternal and neonatal mortality rates. It was demonstrated that it was feasible to provide local healthcare workers with limited training to perform quality scanning and reporting in their clinics. Methods and measures of these three primary outcomes varied between studies. CONCLUSION: Integration of PoCUS into ANC in the settings examined improved outcomes in under-resourced areas. Further research should investigate the availability of PoCUS services at a country level, the clinical impact and economic feasibility.

An Interprofessional Learning Workshop for Mammography and Sonography Students Focusing on Breast Cancer Care and Management Via Simulation: A Pilot Study.

RATIONALE AND OBJECTIVES: The literature surrounding interprofessional education claims that students who learn with, from, and about one another in well-designed interprofessional programs will practice together collaboratively upon graduation, given the skills to do so. The objective of this study was to examine attitudes to interprofessional practice before and after an interprofessional learning (IPL) activity. MATERIALS AND METHODS: A total of 35 postgraduate medical imaging students attended a week-long mammography workshop. The sessions provided a range of didactic sessions related to diagnosis and management of breast cancer. An IPL session was incorporated on completion of the workshop to consolidate learning. Props and authentic resources were used to increase the fidelity of the simulation. Participants completed pre- and post-workshop questionnaires comprising an interprofessional education and collaboration scale and a quiz to gauge knowledge of specific content related to professional roles. Responses to each statement in the scale and quiz score, pre or post workshop, were compared, whereas responses to open-ended questions in post-workshop survey were thematically analyzed. RESULTS: Seventeen paired surveys were received. There was a significant total improvement of 10.66% (P = .036). After simulation, there was a statistically significant improvement in participants' understanding (P < .05) that IPL offers holistic care to the patient and that teamwork is useful for reducing errors in patient care. Simulation helped participants develop more awareness of their role within the profession, improve their understanding of other professionals, and gain more realistic expectations of team members. CONCLUSION: This pilot study confirmed learning within an IPL simulation improved attitudes toward shared learning, teamwork, and communication. Simulation provides opportunities for learning in a safe environment, and technology can be used in diverse ways to provide authentic learning.

The effectiveness of simulation training in the teaching of skills required for sonographic fetal assessment in mid-trimester pregnancy to novices: A pilot study.

INTRODUCTION/PURPOSE: Ultrasound teaching has traditionally relied on access to patients or live model volunteers for the development of trainees' psychomotor skills. With recent developments in technology, simulators are increasingly becoming integrated into formal clinical skills training in medical and allied health education. This study aimed to develop and test the effectiveness of using a high-fidelity ultrasound simulator as the sole training tool to teach mid-trimester obstetric ultrasound skills to novice health and medical professionals who had no previous experience in using ultrasound imaging. METHODS: This pilot study used a prospective cohort design to recruit and train a small sample (n = 10) of health professionals who had no prior experience in obstetric ultrasound skills. The entire training programme used a high-fidelity simulator as the sole skills trainer across three training sessions. Testing points occurred at each session throughout the 5-week training programme. The final testing point, using live model patients, evaluated how well the skills learned using the simulator could be transferred to a more realistic setting. RESULTS/DISCUSSION: The skills of trainees improved and the time taken to perform the skills decreased significantly over the training period. These findings are consistent with a broad acceptance that simulated learning advances psychomotor skills. However, at the final simulator testing, trainees did not reach a level of full competency, and this was replicated in the live model testing. Simulated training to develop obstetric sonography skills appears to be useful in alleviating some of the burden of training from the clinical setting.

The effectiveness of the use of high fidelity simulators in obstetric ultrasound training: A systematic review.

Introduction: The benefits of the use of ultrasound technology for point of care obstetric health evaluation have led to increased focus on training programs for physicians wanting to develop skills in this area. Simulation, in a variety of formats, has always played a role in medical and health training, with proven benefits. This systematic review determines the level of evidence available to support the use of high fidelity ultrasound simulators in the training of obstetric ultrasound scanning skills to health professionals. Methods: A systematic review of the literature was performed to define previous investigations into the incorporation of high fidelity ultrasound simulators into obstetric ultrasound training programs. The included studies were reviewed by the authors to evaluate their overall strength and quality. Data surrounding the study participants, simulator types, study design, training program format, outcome measures, and results were extracted. Results and conclusions: While the small body of evidence discovered in this review demonstrates positive results for the use of high fidelity simulators in obstetric ultrasound training, the studies included in this review demonstrate a moderate level of evidence, with some potential of bias throughout. A number of gaps in the literature were identified that could be addressed in further research.