Imfundo yokude esheshayo ye-point-of-ukunakekelwa kwe-ultrasound phakathi kwabahlinzeki bezokunakekelwa okuphuthumayo abengebona odokotela
Ukufinyelela ekunakekelweni kwezimo eziphuthumayo ezisezingeni eliphakeme emazweni aphansi naphakathi nendawo (i-LMIC) kuyancipha. I-Po-of-care ultrasound (PoCUS) inamandla okwenza ngcono ukunakekelwa okuphuthumayo kuma-LMICs. Isifundo sokude esisheshayo isihluthulelo.
I-POCUS ifakwe ohlelweni lokuqeqeshwa kweqembu labantu abayishumi Abangewona odokotela Abahlinzeka Ngengozi Eziphuthumayo (ECPs) emaphandleni ase-Uganda. Senze ukuhlolwa kokuhlola okulindelekile ngomthelela wesilawuli kude, ukubukeza okusheshayo kwezifundo ze-PoCUS kunhloso eyinhloko yekhwalithi ye-ECP ye-ECP kanye nenhloso yesibili yokusetshenziswa kwe-ultrasound. Ucwaningo olwenziwe ekufundeni okusheshayo lwaluhlukaniswe izigaba ezine ngaphezulu kwezinyanga eziyi-11: inyanga yokuqala yokuqeqeshwa komuntu, amabhlogo izinyanga ezimbili eziphakathi lapho i-ECPs yasebenza khona ngokukhululekile ngaphandle kwempendulo eyi-elektroniki, kanye nezinyanga zokugcina lapho i-ECPs yenze i-ultrasound ngokuzimela ngempendulo eyi-elektroniki ekude .
Ikhwalithi ihlolwe esikalini esivele sishicilelwe samaphuzu ayisishiyagalombili ngumlobi osuselwa kunjiniyela wase-US futhi impendulo eyenziwe yafaniswa ngokushesha inikezwe yi-ECPs ngabasebenzi bendawo. Ukuzwela nokucaciswa kokutholakele kokuhlolwa kwe-ultrasound koHlolo Olugxilisiwe kanye I-Sonography ye-Trauma (FAST) zabalwa.
Imfundo eyihlane esheshayo: isingeniso
Ukufinyelela ekunakekelweni kwezimo eziphuthumayo ezisezingeni eliphakeme emazweni aphansi naphakathi nendawo (i-LMICs) kukhawulelwe, ngaphandle kwekholi yakamuva kakhulu okumele yenziwe ku-2007 yi-WHO. Ngaphezu kwalokho, la mazwe abhekene nengxenye enkulu yomthwalo wezifo wembulunga yonke; amazinga okushona kwezingane, ngokwesibonelo, kuvame ukuba yi-10 kuye kuma-20 izikhathi eziphakeme kuma-LMICs kunasemazweni ahola imali ephezulu.
Izinto eziningi zinomthelela kulokhu kwehluleka ukufinyelela ekunakekelweni, kufaka phakathi ukuntuleka kwabahlinzeki abanamakhono. I-Sub-Saharan Africa ibhekene ne-25% yomthwalo wezifo emhlabeni wonke nge-3% yabasebenzi bezempilo. Ukulwa nalokhu kushoda, amazwe amaningi asebenzise isu elaziwa ngokuthi “ukuguqula umsebenzi” lapho amakhono nezikhundla kusatshalaliswa khona ngezindlela zokunye phakathi kwamakhodi abahlinzeki abakhona kanye namakhodi amasha enziwe kwakudingeka.
Ukushoda kwabahlinzeki abanamakhono kulezi zilungiselelo ezinomkhawulo wezinsizakusebenza kuvame ukuhlanganiswa ngokuzikhandla kwemithombo yezobuchwepheshe, kubandakanya ubuchwepheshe bokuqagela bokucabanga. I-Ultra ephathekayo ethwalwa ngesandla ayibizi, ayisebenzi kalula futhi isebenza kahle ngokomqondo kuzilungiselelo lapho izindlela zokuhlola ezithuthukile zingatholakali. Isifundiso esisheshayo semfundo ye-cadre yabadokotela abangadokotela ku-point-of-ukunakekelwa kwe-ultrasound (PoCUS) ngendlela eqinile futhi esimeme ngakho-ke inamandla okuba nomthelela omkhulu ekuletheni ukunakekelwa kwe-LMICs.
Ucwaningo lwakudala selukhombisile ukuthi odokotela abengebona odokotela bangaqeqeshwa ukuze basebenze ngokuzimele kumakhono abalulekile ekunakekelweni kwezimo eziphuthumayo. Ukusetshenziswa kwe-POCUS ngodokotela kuma-LMICs sekuvele kunomphumela obonakele ekuphathweni kweziguli, njengokukhetha ukwelashwa okuhlinzwa noma ukuguqula uhlelo lokunakekelwa kwezokwelapha.
Imfundo eyihlane esheshayo -Ukucwaningwe okulinganiselwe okuhlola amandla odokotela abengebona odokotela abahlinzeka ukunakekelwa okuphuthumayo kuma-LMICs ukufunda i-PoCUS njengesijobelelo ekunakekelweni okujwayelekile. URobertson et al. ichaze ukusetshenziswa okukude, okwangempela kwesikhathi seFaceTime ukufundisa nokuqapha i-PoCUS ngabangewona odokotela eHaiti naseLevine et al. kukhombisile ukuthi izithombe zeFaceTime ekubuyekezweni kwe-tele-non-be eziphansi kunalezo ezithwetshelwe emshinini we-ultrasound. Kuze kube manje, akukho datha eshicilelwe echaza ukusetshenziswa kwe-tele-ukubuyekeza ukusekela ukusetshenziswa kwe-PoCUS nekhono ngabangewona odokotela kuma-LMICs.
Ngokwesiko, imfundo ye-ultrasound yabahlinzeki isukela ekufundeni okufushane kwezinsuku ezimbili kuya kwezinsuku ezimbili kuya ezifundweni zonyaka owodwa. Amanye amaqembu athole ukuthi ngaphandle kokuxhaswa okuqhubekayo, izikhathi zokuqeqeshwa ezimfushane azivezi ukugcinwa kwamakhono okuqhubekayo. Kodwa-ke, ukuqeqeshwa ngokubhekisisa okwenzeka isikhathi eside komuntu ngamunye ngaseceleni kombhede kungaba nzima kakhulu ekutholeni izinsiza kuma-LMICs, ikakhulukazi uma ukwengamela kunikezwa ochwepheshe okungebona bendawo abahamba beya kuma-LMICs ukuhlinzeka ngemfundo. Lapha sichaza ithuluzi lokufundisa inoveli lokuhlinzeka ngokushesha, "ngocingo-ukubuyekezwa", ukuqinisekiswa kwekhwalithi kanye nempendulo eqenjini labadokotela abangadokotela base-Uganda kanye nomthelela wayo ekuqhubekeni kwemfundo nokugcinwa kwamakhono kwe-PoCUS ebanzi.
Kusukela i-2009, odokotela abengebona odokotela baqeqeshelwe ukunakekelwa kwesimo esiphuthumayo esibhedlela sendawo yasemakhaya e-Uganda, abaneziqu ezibizwa nge-Emergency Care Practitioners (ECPs). Uhlelo lokulungiswa kwesibhedlela kanye nohlelo lokuqeqeshwa kuchazwa ngokuningana kwenye indawo i-PoCUS ifakiwe kukharikhulamu enikezwe ukufinyelela okulinganiselwe ezinsizakalweni ze-radiography. Senze ukuhlolwa kokuhlola okulindelekile ngomthelela wesilawuli kude, ukubukeza okusheshayo kwezifundo ze-PoCUS ngokusetshenziswa kwe-ultrasound namakhono eqenjini labantu abayishumi be-ECP.
Imfundo esheshayo eyihlane - Izindlela
Konke ukuhlangana kweziguli kwangenwa ngemvume endaweni yokucwaninga kagesi. Imininingwane eqoqwe yayihlanganisa isikhalazo esiyinhloko, imininingwane yabantu, ukuhlola oku-vedwe noma kwenziwa (kufaka phakathi i-ECP POCUS), imiphumela kanye nokuchazwa. I-ECPs ithole izithombe ze-ultrasound nge-Sonosite Micromaxx (Bothell, WA) isebenzisa i-2-5 mHz curvilinear transducer, 6-13 mHz linear transducer, noma i-1-5 mHz transducer ngezigaba.
Ngokuphathelene nemfundo esheshayo ekude, njengengxenye yocwaningo lokucwaninga, imininingwane nge-ultrasound eyenziwe, i-sonographing nokuhunyushwa kokuqala kwaqoshwa yi-ECPs kwabe kulayishwa ngabasebenzi ohlelweni lwe-database olususelwe kuwebhu olwenziwe omunye wababhali (* *) isiqinisekiso sekhwalithi elikude. Ukubuyekezwa kwezithombe kwenziwa kude ngudokotela ophuthumayo osuselwe e-US ngokuqeqeshwa kwenhlanganyelo e-PoCUS. Imibiko enemininingwane yathunyelwa nge-imeyili kubasebenzi abacwaningi bendawo abaphrinte futhi basakaza impendulo kuma-ECPs enza.
Inhloso yethu eyinhloko ibandakanya izinguquko ezilinganisweni zemfundo ngemuva kwesikhathi (ukutolika nokutholwa kwesithombe). Inhloso yethu yesibili yayiqukethe ukusetshenziswa kwe-ultrasound. Ama-Ultrasounds enziwa ngokuzimela ngokuhambela odokotela awakhiswanga ngaphandle. Lo msebenzi wamukelwa yi-Institutional ukubuyekeza Boards of [deidifieded and [deidised].