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.
PLoS One. 2020 Jun 30;15(6):e0235269. doi: 10.1371/journal.pone.0235269. eCollection 2020.
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.
许多高危妊娠情况直到低收入国家分娩时才被发现。我们为乌干达农村地区的医务人员制定了一个即时护理超声培训方案，以检测胎儿窘迫或死亡、胎位不正、多胎妊娠、前置胎盘、羊水过少和早产。这是一项混合方法研究，旨在评估为期两周的培训课程和学员执行标准扫描方案和解读超声图像的能力。在培训前、培训后立即和 3 个月随访时进行了评估提供者信心的调查。在讲座和实践演示之后，每位学员进行了 25 次监督扫描，并需要通过观察性结构化临床考试（OSCE）。课程结束后 8 周内，由两名超声专家对所有图像进行盲法审查，以评估图像质量并识别常见错误。关键知情人访谈进一步评估了对培训计划和即时护理超声的看法。所有访谈均进行了录音，并由多名读者使用内容分析法进行转录和审查。来自一个地区医院和三个保健中心的 23 名护士/助产士和 2 名医生参加了培训课程。所有措施的信心水平从课前的平均 1 分提高到课后的 6 分以上（最高 7 分）。在 25 名参与者中，有 22 人在第一次尝试时通过了 OSCE（平均得分为 89.4%）。图像质量随着时间的推移而提高；第 8 周的最终错误率低于 5%，两位审阅者之间的所有措施的总体 Kappa 值为 0.8-1。在进行的 12 次关键知情人访谈中，主要主题包括对手动培训的需求增加、培训时间延长以及平衡临床职责与参加培训课程能力之间的挑战。这项研究表明，没有超声经验的提供者在培训后可以以较高的质量和准确性检测到分娩期间的高危情况。
