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Efficacy of an ultrasound training program for nurse midwives to assess high-risk conditions at labor triage in rural Uganda.
PLoS One. 2020; 15(6):e0235269.Plos

Abstract

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.

Authors+Show Affiliations

Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA, United States of America.Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America.Iganga General Hospital, Iganga, Uganda.Iganga General Hospital, Iganga, Uganda.Iganga General Hospital, Iganga, Uganda.Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America. Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America.Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States of America.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32603339

Citation

Shah, Sachita, et al. "Efficacy of an Ultrasound Training Program for Nurse Midwives to Assess High-risk Conditions at Labor Triage in Rural Uganda." PloS One, vol. 15, no. 6, 2020, pp. e0235269.
Shah S, Santos N, Kisa R, et al. Efficacy of an ultrasound training program for nurse midwives to assess high-risk conditions at labor triage in rural Uganda. PLoS ONE. 2020;15(6):e0235269.
Shah, S., Santos, N., Kisa, R., Mike Maxwell, O., Mulowooza, J., Walker, D., & Muruganandan, K. M. (2020). Efficacy of an ultrasound training program for nurse midwives to assess high-risk conditions at labor triage in rural Uganda. PloS One, 15(6), e0235269. https://doi.org/10.1371/journal.pone.0235269
Shah S, et al. Efficacy of an Ultrasound Training Program for Nurse Midwives to Assess High-risk Conditions at Labor Triage in Rural Uganda. PLoS ONE. 2020;15(6):e0235269. PubMed PMID: 32603339.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of an ultrasound training program for nurse midwives to assess high-risk conditions at labor triage in rural Uganda. AU - Shah,Sachita, AU - Santos,Nicole, AU - Kisa,Rose, AU - Mike Maxwell,Odida, AU - Mulowooza,Jude, AU - Walker,Dilys, AU - Muruganandan,Krithika Meera, Y1 - 2020/06/30/ PY - 2020/02/05/received PY - 2020/06/11/accepted PY - 2020/7/1/entrez PY - 2020/7/1/pubmed PY - 2020/7/1/medline SP - e0235269 EP - e0235269 JF - PloS one JO - PLoS ONE VL - 15 IS - 6 N2 - 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. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/32603339/Efficacy_of_an_ultrasound_training_program_for_nurse_midwives_to_assess_high-risk_conditions_at_labor_triage_in_rural_Uganda L2 - https://dx.plos.org/10.1371/journal.pone.0235269 DB - PRIME DP - Unbound Medicine ER -
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