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Efficacy of an ultrasound training program for nurse midwives to assess high-risk conditions at labor triage in rural Uganda

Many high-risk conditions of pregnancy are undetected until the time of delivery in low-income countries. We developed a point-of-care ultrasound training protocol for providers in rural Uganda to detect fetal distress or demise, malpresentation, multiple gestation, placenta previa, oligohydramnios...

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Autores principales: Shah, Sachita, Santos, Nicole, Kisa, Rose, Mike Maxwell, Odida, Mulowooza, Jude, Walker, Dilys, Muruganandan, Krithika Meera
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326214/
https://www.ncbi.nlm.nih.gov/pubmed/32603339
http://dx.doi.org/10.1371/journal.pone.0235269
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author Shah, Sachita
Santos, Nicole
Kisa, Rose
Mike Maxwell, Odida
Mulowooza, Jude
Walker, Dilys
Muruganandan, Krithika Meera
author_facet Shah, Sachita
Santos, Nicole
Kisa, Rose
Mike Maxwell, Odida
Mulowooza, Jude
Walker, Dilys
Muruganandan, Krithika Meera
author_sort Shah, Sachita
collection PubMed
description Many high-risk conditions of pregnancy are undetected until the time of delivery in low-income countries. We developed a point-of-care ultrasound training protocol for providers in rural Uganda to detect fetal distress or demise, malpresentation, multiple gestation, placenta previa, oligohydramnios and preterm delivery. This was a mixed-methods study to evaluate the 2-week training curriculum and trainees' ability to perform a standard scanning protocol and interpret ultrasound images. Surveys to assess provider confidence were administered pre-training, immediately after, and at 3-month follow up. Following lecture and practical demonstrations, each trainee conducted 25 proctored scans and were required to pass an observed structured clinical exam (OSCE). All images produced 8 weeks post course underwent blinded review by two ultrasound experts to assess image quality and to identify common errors. Key informant interviews further assessed perceptions of the training program and utility of point-of-care ultrasound. All interviews were audio recorded, transcribed, and reviewed by multiple readers using a content analysis approach. Twenty-three nurse/nurse midwives and two physicians from one district hospital and three health centers participated in the training curriculum. Confidence levels increased from an average of 1 point pre-course to over 6 points post-course for all measures (maximum of 7 points). Of 25 participants, 22 passed the OSCE on the first attempt (average score 89.4%). Image quality improved over time; the final error rate at week 8 was less than 5%, with an overall kappa of 0.8–1 for all measures between the two reviewers. Among the 12 key informant interviews conducted, key themes included a desire for more hands-on training and longer duration of training and challenges in balancing clinical duties with ability to attend training sessions. This study demonstrates that providers without previous ultrasound experience can detect high-risk conditions during labor with a high rate of quality and accuracy after training.
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spelling pubmed-73262142020-07-10 Efficacy of an ultrasound training program for nurse midwives to assess high-risk conditions at labor triage in rural Uganda Shah, Sachita Santos, Nicole Kisa, Rose Mike Maxwell, Odida Mulowooza, Jude Walker, Dilys Muruganandan, Krithika Meera PLoS One Research Article Many high-risk conditions of pregnancy are undetected until the time of delivery in low-income countries. We developed a point-of-care ultrasound training protocol for providers in rural Uganda to detect fetal distress or demise, malpresentation, multiple gestation, placenta previa, oligohydramnios and preterm delivery. This was a mixed-methods study to evaluate the 2-week training curriculum and trainees' ability to perform a standard scanning protocol and interpret ultrasound images. Surveys to assess provider confidence were administered pre-training, immediately after, and at 3-month follow up. Following lecture and practical demonstrations, each trainee conducted 25 proctored scans and were required to pass an observed structured clinical exam (OSCE). All images produced 8 weeks post course underwent blinded review by two ultrasound experts to assess image quality and to identify common errors. Key informant interviews further assessed perceptions of the training program and utility of point-of-care ultrasound. All interviews were audio recorded, transcribed, and reviewed by multiple readers using a content analysis approach. Twenty-three nurse/nurse midwives and two physicians from one district hospital and three health centers participated in the training curriculum. Confidence levels increased from an average of 1 point pre-course to over 6 points post-course for all measures (maximum of 7 points). Of 25 participants, 22 passed the OSCE on the first attempt (average score 89.4%). Image quality improved over time; the final error rate at week 8 was less than 5%, with an overall kappa of 0.8–1 for all measures between the two reviewers. Among the 12 key informant interviews conducted, key themes included a desire for more hands-on training and longer duration of training and challenges in balancing clinical duties with ability to attend training sessions. This study demonstrates that providers without previous ultrasound experience can detect high-risk conditions during labor with a high rate of quality and accuracy after training. Public Library of Science 2020-06-30 /pmc/articles/PMC7326214/ /pubmed/32603339 http://dx.doi.org/10.1371/journal.pone.0235269 Text en © 2020 Shah et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Shah, Sachita
Santos, Nicole
Kisa, Rose
Mike Maxwell, Odida
Mulowooza, Jude
Walker, Dilys
Muruganandan, Krithika Meera
Efficacy of an ultrasound training program for nurse midwives to assess high-risk conditions at labor triage in rural Uganda
title Efficacy of an ultrasound training program for nurse midwives to assess high-risk conditions at labor triage in rural Uganda
title_full Efficacy of an ultrasound training program for nurse midwives to assess high-risk conditions at labor triage in rural Uganda
title_fullStr Efficacy of an ultrasound training program for nurse midwives to assess high-risk conditions at labor triage in rural Uganda
title_full_unstemmed Efficacy of an ultrasound training program for nurse midwives to assess high-risk conditions at labor triage in rural Uganda
title_short Efficacy of an ultrasound training program for nurse midwives to assess high-risk conditions at labor triage in rural Uganda
title_sort efficacy of an ultrasound training program for nurse midwives to assess high-risk conditions at labor triage in rural uganda
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326214/
https://www.ncbi.nlm.nih.gov/pubmed/32603339
http://dx.doi.org/10.1371/journal.pone.0235269
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