Nathan Robert O, Swanson Jonathan O, Swanson David L, McClure Elizabeth M, Bolamba Victor Lokomba, Lokangaka Adrien, Pineda Irma Sayury, Figueroa Lester, López-Gomez Walter, Garces Ana, Muyodi David, Esamai Fabian, Kanaiza Nancy, Mirza Waseem, Naqvi Farnaz, Saleem Sarah, Mwenechanya Musaku, Chiwila Melody, Hamsumonde Dorothy, Wallace Dennis D, Franklin Holly, Goldenberg Robert L
Department of Radiology, Harborview Medical Center, University of Washington Medical Center, Seattle, WA.
Department of Statistics and Epidemiology, RTI International, Durham, NC.
Curr Probl Diagn Radiol. 2017 May-Jun;46(3):210-215. doi: 10.1067/j.cpradiol.2016.11.001. Epub 2016 Nov 10.
Prior studies have suggested that obstetrical (OB) ultrasound in low- and middle-income countries has aided in detection of high-risk conditions, which in turn could improve OB management. We are participating in a cluster-randomized clinical trial of OB ultrasound, which is designed to assess the effect of basic OB ultrasound on maternal mortality, fetal mortality, neonatal mortality, and maternal near-miss in 5 low-income countries. We designed a 2-week course in basic OB ultrasound, followed by 12 weeks of oversight, to train health care professionals with no prior ultrasound experience to perform basic OB ultrasound to screen for high-risk pregnancies. All patients with high-risk pregnancies identified by the trainees were referred to higher-level health facilities where fully trained sonographers confirmed the diagnoses before any actions were taken. Although there have been several published studies on basic OB ultrasound training courses for health care workers in low- and middle-income countries, quality control reporting has been limited. The purpose of this study is to report on quality control results of these trainees. Health care workers trained in similar courses could have an adjunctive role in ultrasound screening for high-risk OB conditions where access to care is limited. After completion of the ultrasound course, 41 trainees in 5 countries performed 3801 ultrasound examinations during a 12-week pilot period. Each examination was reviewed by ultrasound trainers for errors in scanning parameters and errors in diagnosis, using predetermined criteria. Of the 32,480 images comprising the 3801 examinations, 94.8% were rated as satisfactory by the reviewers. There was 99.4% concordance between trainee and reviewer ultrasound diagnosis. The results suggest that trained health care workers could play a role in ultrasound screening for high-risk OB conditions.
先前的研究表明，低收入和中等收入国家的产科（OB）超声有助于检测高危情况，进而改善产科管理。我们正在参与一项关于产科超声的整群随机临床试验，该试验旨在评估基础产科超声对5个低收入国家孕产妇死亡率、胎儿死亡率、新生儿死亡率和孕产妇严重并发症的影响。我们设计了一个为期2周的基础产科超声课程，随后进行12周的监督，以培训没有超声经验的医护人员进行基础产科超声检查，筛查高危妊娠。学员识别出的所有高危妊娠患者均被转诊至更高水平的医疗机构，由经过全面培训的超声医师在采取任何行动之前确认诊断。尽管已经有几项关于低收入和中等收入国家医护人员基础产科超声培训课程的发表研究，但质量控制报告有限。本研究的目的是报告这些学员的质量控制结果。在医疗服务受限的地区，接受类似课程培训的医护人员在超声筛查高危产科情况方面可以发挥辅助作用。超声课程结束后，5个国家的41名学员在为期12周的试点期间进行了3801次超声检查。超声培训师使用预定标准对每次检查的扫描参数错误和诊断错误进行了审查。在构成3801次检查的32480张图像中，94.8%被评审人员评为满意。学员和评审人员的超声诊断一致性为99.4%。结果表明，经过培训的医护人员可以在超声筛查高危产科情况中发挥作用。
