Ultrasound in Resource-Limited Settings: A Case Based, Open Access Text

Faculty at UC Davis Health in collaboration with the California Digital Library (CDL) and Blaisdell Medical Library are pleased to announce the release of Ultrasound in Resource-Limited Settings: A Case Based, Open Access Text. This new online resource aims to provide an open access clinical resource for radiologists and clinicians who practice ultrasound in low and limited resourced healthcare settings. The project was conceived of and developed by two UC Davis Health physicians: Michael Schick and Rebecca Stein-Wexler, with help from Aida Nasirishargh as the online editor. Drs. Schick and Stein-Wexler have been teaching and using ultrasound for many years in some of the least resourced healthcare settings in the world. In these regions, most people have no access to diagnostic imaging.  Ultrasound is particularly positioned to help fill this gap as the most portable, inexpensive, and versatile form of diagnostic imaging. 

“While caring for patients and teaching ultrasound in the most low resourced health settings in the world, we routinely diagnose illnesses such as rheumatic heart disease and extra-pulmonary tuberculosis,” said Dr. Schick. “Many conditions we encounter are considered ‘neglected’ and rare in high income countries, but are becoming increasingly relevant with global travel, migration, and population displacement. When we tried to learn more about the ultrasound diagnostics of these diseases and find high quality images and videos for teaching our global trainees, we noticed a lack of available resources. Standard texts offer ample education about diseases that are common throughout the world. However, they fall short in building the expertise that is needed by those who practice in limited-resourced and tropical regions.”

The team’s goal was to create an up-to-date and useful resource for those who use ultrasound to take care of vulnerable patients around the globe. Drs. Schick and Stein-Wexler envisioned a text that was concise and clinically relevant, with high quality images and discussion that could be easily accessed, shared and downloaded in areas with limited internet bandwidth — a living text that would be translated into multiple languages and continue to grow as future impactful cases were identified and new techniques were discovered.

The project is a collaborative effort by health care practitioners worldwide who use point-of-care and comprehensive ultrasound. Each chapter is authored by experts with case-based knowledge of both ultrasound and the highlighted disease. The chapters are 100% case based and provide important insight into how experts practice medicine and apply ultrasound in the limited resourced healthcare setting. As you scroll through chapters, high quality videos (in bandwidth-efficient GIF format) play automatically, and full-resolution video files are available for download and sharing.

When Drs. Schick and Stein-Wexler consulted with Blaisdell Medical Library about publishing options for this unique work, health sciences librarian Amy Studer saw the opportunity to connect them with CDL to investigate the possibility of hosting their work on an open access publishing platform. “This publication, by virtue of its intended audience and goals, is particularly concerned with issues of accessibility and discoverability, and CDL’s eScholarship Publishing program shares that commitment. We regard this publication as an important step forward in redesigning medical publications for the specific needs of users in the field,” says Studer.

Because of the large number of videos and images needed to illustrate the concepts in the text, CDL identified the Manifold platform as the best system for building and displaying the work. “Foundational to the Manifold platform is the ability to harness dynamic web content as an integral component of a publication, layering text and media alongside one another in an intuitive reader that encourages thoughtful engagement,” said Terence Smyre, Manifold Digital Projects Editor. “Manifold’s open-source, open-access ethos is also specifically aimed at the public good — values that align strongly with the goals of the project.”

This publication also represents the first project completed under the eScholarship Labs program at California Digital Library. “We launched the Scholarship Labs program in 2019 with the aim of fostering innovation in scholarly publishing by piloting new publishing technologies to support experimental forms of scholarship,” said Justin Gonder, Senior Product Manager, Publishing at CDL. “Manifold has now graduated from the Labs program and is available for use by any member of the University of California community who has a scholarly project in mind that requires deep integration of text and media.” For more information, visit the eScholarship Help Center.

In the coming months, Ultrasound in Resource-Limited Settings will be released in several different languages including Spanish and Farci, initially, with many others to follow. If you would like to contribute to additional translations of this resource, please contact the editors: mschick@ucdavis.edu and rsteinwexler@ucdavis.edu.

Ultrasound in Resource-Limited Settings: A Case Based, Open Access Text is available now at:
https://manifold.escholarship.org/projects/ultrasound-in-resource-limited-settings

Michael Schick DO, MA, DIMPH, FACEP
Associate Clinical Professor, Emergency Medicine
Director, International Ultrasound
Co-Director, Technology Enabled Active Learning
Director of Ultrasound, Global Emergency Care

Rebecca Stein-Wexler, M.D.
Professor of Radiology
Section Chief, Pediatric Radiology
Director, Global Radiology Education and Outreach
University of California, Davis Medical Center
and UC Davis Children’s Hospital