Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Jhpiego Lesotho, Maseru, Lesotho.
BMJ Open. 2022 Apr 29;12(4):e058643. doi: 10.1136/bmjopen-2021-058643.
To develop and implement a 'low-dose, high-frequency' (LDHF) advanced respiratory care training programme for COVID-19 care in Lesotho.
Prospective pretraining-post-training evaluation.
Lesotho has limited capacity in advanced respiratory care.
Physicians and nurses.
Due to limited participation in May-September 2020, the LDHF approach was modified into a traditional 1-day offsite training in November 2020 that reviewed respiratory anatomy and physiology, clinical principles for conventional oxygen, heated high-flow nasal cannula and non-invasive ventilation management. Basic mechanical ventilation principles were introduced.
Participants completed a 20-question multiple choice examination immediately before and after the 1-day training. Paired t-tests were used to evaluate the difference in average participant pretraining and post-training examination scores.
Pretraining and post-training examinations were completed by 46/53 (86.7%) participants, of whom 93.4% (n=43) were nurses. The overall mean pretraining score was 44.8% (SD 12.4%). Mean scores improved by an average of 23.7 percentage points (95% CI 19.7 to 27.6, p<0.001) on the post-training examination to a mean score of 68.5% (SD 13.6%). Performance on basic and advanced respiratory categories also improved by 17.7 (95% CI 11.6 to 23.8) and 25.6 percentage points (95% CI 20.4 to 30.8) (p<0.001). Likewise, mean examination scores increased on the post-training test, compared with pretraining, for questions related to respiratory management (29.6 percentage points, 95% CI 24.1 to 35.0) and physiology (17.4 percentage points, 95% CI 12.0 to 22.8).
An LDHF training approach was not feasible during this early emergency period of the COVID-19 pandemic in Lesotho. Despite clear knowledge gains, the modest post-training examination scores coupled with limited physician engagement suggest healthcare workers require alternative educational strategies before higher advanced care like mechanical ventilation is implementable. Conventional and high-flow oxygen is better aligned with post-training healthcare worker knowledge levels and rapid implementation.
在莱索托为 COVID-19 护理开发和实施“低剂量、高频率”（LDHF）高级呼吸治疗培训计划。
培训前评估-培训后评估。
莱索托的高级呼吸治疗能力有限。
医生和护士。
由于 2020 年 5 月至 9 月期间参与人数有限，2020 年 11 月将 LDHF 方法修改为为期 1 天的异地培训，复习呼吸解剖和生理学、常规吸氧、加热高流量鼻插管和无创通气管理的临床原则。介绍了基本的机械通气原则。
46/53（86.7%）名参与者完成了 1 天培训前后的 20 道多项选择题考试。采用配对 t 检验评估参与者培训前和培训后考试平均成绩的差异。
参与者在基础和高级呼吸类别中的表现也分别提高了 17.7（95%CI 11.6 至 23.8）和 25.6 个百分点（95%CI 20.4 至 30.8）（p<0.001）。同样，与培训前相比，与呼吸管理（29.6 个百分点，95%CI 24.1 至 35.0）和生理学（17.4 个百分点，95%CI 12.0 至 22.8）相关的问题的培训后考试的平均分数也有所提高。
