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Gifford A, Philemon R, Halbert J, Hothersall EJ, Inglis R, Hart J, Byrne-Davis L, Thirsk J, Gifford H, Howells R, Weetch S, Prentice K, Jackson A, Kirkpatrick M. A narrative review of course evaluation methods for continuing professional development: The case of paediatric and neonatal acute-care in-service courses in low and lower-middle income countries: BEME Guide No. 76. MEDICAL TEACHER 2023; 45:685-697. [PMID: 36369858 DOI: 10.1080/0142159x.2022.2137010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Training a skilled healthcare workforce is an essential part in reaching the United Nations Sustainable Development Goal to end preventable deaths in children and neonates. The greatest burden of mortality lies in low and lower-middle income countries (LLMIC). Short term, in-service courses have been implemented in many LLMIC to improve the quality of care delivered, but the evaluation methods of these courses are inconsistent. METHOD Studies describing evaluations of course and outcome measures were included if the course lasted seven days or less with postgraduate participants, included paediatric or neonatal acute or emergency training and was based in a LLMIC. This narrative review provides a detailed description of evaluation methods of course content, delivery and outcome measures based on 'Context, Input, Process and Product' (CIPP) and Kirkpatrick models. RESULTS 5265 titles were screened with 93 articles included after full-text review and quality assessment. Evaluation methods are described: context, input, process, participant satisfaction, change in learning, behaviour, health system infrastructure and patient outcomes. CONCLUSIONS Outcomes, including mortality and morbidity, are rightly considered the fundamental aim of acute-care courses in LLMIC. Course evaluation can be difficult, especially with low resources, but this review outlines what can be done to guide future course organisers in providing well-conducted courses with consistent outcome measures for maximum sustainable impact.
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Affiliation(s)
| | - Rune Philemon
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jay Halbert
- Department of Paediatrics, University College Hospital, London, England
| | | | - Rebecca Inglis
- Intensive Care Medicine, University of Oxford, Oxford, England
| | - Jo Hart
- Division of Medical Education, University of Manchester, Manchester, England
| | | | - Joanna Thirsk
- University Hospital Southampton NHS Foundation Trust, Southampton, England
| | | | - Rachel Howells
- Royal Devon and Exeter NHS Foundation Trust, Exeter, England
| | - Shona Weetch
- Clinical Development, NHS Greater Glasgow and Clyde, Glasgow, Scotland
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Do SN, Luong CQ, Pham DT, Nguyen MH, Nguyen NT, Huynh DQ, Hoang QTA, Dao CX, Le TM, Bui HN, Nguyen HT, Hoang HB, Le TTP, Nguyen LTB, Duong PT, Nguyen TD, Vu YH, Pham GTT, Van Bui T, Pham TTN, Hoang HT, Van Bui C, Nguyen NM, Bui GTH, Vu TD, Le ND, Tran TH, Nguyen TQ, Le VH, Van Nguyen C, McNally BF, Phua J, Nguyen AD. Factors relating to mortality in septic patients in Vietnamese intensive care units from a subgroup analysis of MOSAICS II study. Sci Rep 2021; 11:18924. [PMID: 34556710 PMCID: PMC8460806 DOI: 10.1038/s41598-021-98165-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/06/2021] [Indexed: 12/29/2022] Open
Abstract
Sepsis is the most common cause of in-hospital deaths, especially from low-income and lower-middle-income countries (LMICs). This study aimed to investigate the mortality rate and associated factors from sepsis in intensive care units (ICUs) in an LMIC. We did a multicenter cross-sectional study of septic patients presenting to 15 adult ICUs throughout Vietnam on the 4 days representing the different seasons of 2019. Of 252 patients, 40.1% died in hospital and 33.3% died in ICU. ICUs with accredited training programs (odds ratio, OR: 0.309; 95% confidence interval, CI 0.122-0.783) and completion of the 3-h sepsis bundle (OR: 0.294; 95% CI 0.083-1.048) were associated with decreased hospital mortality. ICUs with intensivist-to-patient ratio of 1:6 to 8 (OR: 4.533; 95% CI 1.621-12.677), mechanical ventilation (OR: 3.890; 95% CI 1.445-10.474) and renal replacement therapy (OR: 2.816; 95% CI 1.318-6.016) were associated with increased ICU mortality, in contrast to non-surgical source control (OR: 0.292; 95% CI 0.126-0.678) which was associated with decreased ICU mortality. Improvements are needed in the management of sepsis in Vietnam such as increasing resources in critical care settings, making accredited training programs more available, improving compliance with sepsis bundles of care, and treating underlying illness and shock optimally in septic patients.
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Affiliation(s)
- Son Ngoc Do
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, 100000, Vietnam.,Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, 100000, Vietnam
| | - Chinh Quoc Luong
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam. .,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, 100000, Vietnam. .,Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, 100000, Vietnam.
| | - Dung Thi Pham
- Department of Nutrition and Food Safety, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, 410000, Vietnam
| | - My Ha Nguyen
- Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, 410000, Vietnam
| | - Nga Thi Nguyen
- Department of Intensive Care and Poison Control, Vietnam-Czechoslovakia Friendship Hospital, Hai Phong, 180000, Vietnam
| | - Dai Quang Huynh
- Intensive Care Department, Cho Ray Hospital, Ho Chi Minh City, 700000, Vietnam.,Department of Critical Care, Emergency Medicine and Clinical Toxicology, Faculty of Medicine, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, 700000, Vietnam
| | - Quoc Trong Ai Hoang
- Emergency Department, Hue Central General Hospital, Hue City, Thua Thien Hue, 530000, Vietnam
| | - Co Xuan Dao
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, 100000, Vietnam.,Department of Intensive Care, Bach Mai Hospital, Hanoi, 100000, Vietnam
| | - Trung Minh Le
- Intensive Care Unit, 115 People's Hospital, Ho Chi Minh City, 700000, Vietnam
| | - Ha Nhat Bui
- Intensive Care Unit, Bai Chay General Hospital, Quang Ninh, 200000, Vietnam
| | - Hung Tan Nguyen
- Intensive Care Unit, Da Nang Hospital, Da Nang, 550000, Vietnam
| | - Hai Bui Hoang
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, 100000, Vietnam.,Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, 100000, Vietnam
| | | | | | - Phuoc Thien Duong
- Intensive Care Unit, Can Tho Central General Hospital, Can Tho, 900000, Vietnam
| | - Tuan Dang Nguyen
- Intensive Care Unit, Vinmec Times City International Hospital, Hanoi, 100000, Vietnam
| | - Yen Hai Vu
- Intensive Care Unit, Da Nang Hospital, Da Nang, 550000, Vietnam.,Intensive Care Unit, Thai Nguyen Central General Hospital, Thai Nguyen, 250000, Vietnam
| | - Giang Thi Tra Pham
- Emergency Department, Thanh Nhan General Hospital, Hanoi, 100000, Vietnam
| | - Tam Van Bui
- Department of Intensive Care and Poison Control, Vietnam-Czechoslovakia Friendship Hospital, Hai Phong, 180000, Vietnam
| | - Thao Thi Ngoc Pham
- Intensive Care Department, Cho Ray Hospital, Ho Chi Minh City, 700000, Vietnam.,Department of Critical Care, Emergency Medicine and Clinical Toxicology, Faculty of Medicine, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, 700000, Vietnam
| | - Hanh Trong Hoang
- Intensive Care Unit, Hue Central General Hospital, Hue City, Thua Thien Hue, 530000, Vietnam.,Department of Emergency and Critical Care Medicine, Faculty of Medicine, Hue University of Medicine and Pharmacy, Hue City, Thua Thien Hue, 530000, Vietnam
| | - Cuong Van Bui
- Department of Intensive Care, Bach Mai Hospital, Hanoi, 100000, Vietnam
| | - Nguyen Minh Nguyen
- Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Giang Thi Huong Bui
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, 100000, Vietnam.,Department of Intensive Care, Bach Mai Hospital, Hanoi, 100000, Vietnam
| | - Thang Dinh Vu
- Intensive Care Unit, 115 People's Hospital, Ho Chi Minh City, 700000, Vietnam
| | - Nhan Duc Le
- Intensive Care Unit, Da Nang Hospital, Da Nang, 550000, Vietnam
| | - Trang Huyen Tran
- Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Thang Quang Nguyen
- Intensive Care Unit, Vinmec Times City International Hospital, Hanoi, 100000, Vietnam
| | - Vuong Hung Le
- Intensive Care Unit, Thai Nguyen Central General Hospital, Thai Nguyen, 250000, Vietnam
| | - Chi Van Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Bryan Francis McNally
- Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA.,Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Jason Phua
- FAST and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore, 159964, Singapore.,Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Health System, Singapore, 119228, Singapore
| | - Anh Dat Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, 100000, Vietnam
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Nayahangan LJ, Konge L, Russell L, Andersen S. Training and education of healthcare workers during viral epidemics: a systematic review. BMJ Open 2021; 11:e044111. [PMID: 34049907 PMCID: PMC8166630 DOI: 10.1136/bmjopen-2020-044111] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 05/11/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND It is necessary to train a large number of healthcare workers (HCW) within a limited time to ensure adequate human resources during an epidemic. There remains an urgent need for best practices on development and implementation of training programmes. OBJECTIVE To explore published literature in relation to training and education for viral epidemics as well as the effect of these interventions to inform training of HCW. DATA SOURCES Systematic searches in five databases performed between 1 January 2000 and 24 April 2020 for studies reporting on educational interventions in response to major viral epidemics. STUDY ELIGIBILITY CRITERIA All studies on educational interventions developed, implemented and evaluated in response to major global viral outbreaks from 2000 to 2020. PARTICIPANTS Healthcare workers. INTERVENTIONS Educational or training interventions. STUDY APPRAISAL AND SYNTHESIS METHODS Descriptive information were extracted and synthesised according to content, competency category, educational methodology, educational effects and level of educational outcome. Quality appraisal was performed using a criterion-based checklist. RESULTS A total of 15 676 records were identified and 46 studies were included. Most studies were motivated by the Ebola virus outbreak with doctors and nurses as primary learners. Traditional didactic methods were commonly used to teach theoretical knowledge. Simulation-based training was used mainly for training of technical skills, such as donning and doffing of personal protective equipment. Evaluation of the interventions consisted mostly of surveys on learner satisfaction and confidence or tests of knowledge and skills. Only three studies investigated transfer to the clinical setting or effect on patient outcomes. CONCLUSIONS AND IMPLICATIONS OF FINDINGS The included studies describe important educational experiences from past epidemics with a variety of educational content, design and modes of delivery. High-level educational evidence is limited. Evidence-based and standardised training programmes that are easily adapted locally are recommended in preparation for future outbreaks.
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Affiliation(s)
- Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resouces and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resouces and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Russell
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resouces and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Steven Andersen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resouces and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Otorhinolaryngology-Head & Neck Surgery, Rigshospitalet, Copenhagen, Denmark
- Department of Otolaryngology, Ohio State University, Columbus, Ohio, USA
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4
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Muttalib F, González-Dambrauskas S, Lee JH, Steere M, Agulnik A, Murthy S, Adhikari NKJ. Pediatric Emergency and Critical Care Resources and Infrastructure in Resource-Limited Settings: A Multicountry Survey. Crit Care Med 2021; 49:671-681. [PMID: 33337665 DOI: 10.1097/ccm.0000000000004769] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the infrastructure and resources for pediatric emergency and critical care delivery in resource-limited settings worldwide. DESIGN Cross-sectional survey with survey items developed through literature review and revised following piloting. SETTING The electronic survey was disseminated internationally in November 2019 via e-mail directories of pediatric intensive care societies and networks and using social media. PATIENTS Healthcare providers who self-identified as working in resource-limited settings. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Results were summarized using descriptive statistics and resource availability was compared across World Bank country income groups. We received 328 responses (238 hospitals, 60 countries), predominantly in Latin America and Sub-Saharan Africa (n = 161, 67.4%). Hospitals were in low-income (28, 11.7%), middle-income (166, 69.5%), and high-income (44, 18.4%) countries. Across 174 PICU and adult ICU admitting children, there were statistically significant differences in the proportion of hospitals reporting consistent resource availability ("often" or "always") between country income groups (p < 0·05). Resources with limited availability in lower income countries included advanced ventilatory support, invasive and noninvasive monitoring, central venous access, renal replacement therapy, advanced imaging, microbiology, biochemistry, blood products, antibiotics, parenteral nutrition, and analgesic/sedative drugs. Seventy-seven ICUs (52.7%) were staffed 24/7 by a pediatric intensivist or anesthetist. The nurse-to-patient ratio was less than 1:2 in 71 ICUs (49.7%). CONCLUSIONS Contemporary data demonstrate significant disparity in the availability of essential and advanced human and material resources for the care of critically ill children in resource-limited settings. Minimum standards for essential pediatric emergency and critical care in resource-limited settings are needed.
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Affiliation(s)
- Fiona Muttalib
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Sebastián González-Dambrauskas
- Cuidados Intensivos Pediátricos Especializados, Casa de Galicia, Montevideo, Uruguay
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
| | - Jan Hau Lee
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
- Cuidados Intensivos Pediátricos Especializados, Casa de Galicia, Montevideo, Uruguay
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Children's Intensive Care, KK Women's and Children's Hospital, Singapore
- Department of Pediatrics, Duke-NUS Medical School, Singapore
- Pediatric Acute and Critical Care Medicine Asian Network
- Department of Pediatrics, AIC Kijabe Hospital, Kijabe, Kenya
- Pediatric Emergency and Critical Care Africa
- Royal Flying Doctor Service of Australia, Central Operations, Mile End, SA, Australia
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Mardi Steere
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
- Cuidados Intensivos Pediátricos Especializados, Casa de Galicia, Montevideo, Uruguay
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Children's Intensive Care, KK Women's and Children's Hospital, Singapore
- Department of Pediatrics, Duke-NUS Medical School, Singapore
- Pediatric Acute and Critical Care Medicine Asian Network
- Department of Pediatrics, AIC Kijabe Hospital, Kijabe, Kenya
- Pediatric Emergency and Critical Care Africa
- Royal Flying Doctor Service of Australia, Central Operations, Mile End, SA, Australia
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Srinivas Murthy
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Neill K J Adhikari
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
- Cuidados Intensivos Pediátricos Especializados, Casa de Galicia, Montevideo, Uruguay
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Children's Intensive Care, KK Women's and Children's Hospital, Singapore
- Department of Pediatrics, Duke-NUS Medical School, Singapore
- Pediatric Acute and Critical Care Medicine Asian Network
- Department of Pediatrics, AIC Kijabe Hospital, Kijabe, Kenya
- Pediatric Emergency and Critical Care Africa
- Royal Flying Doctor Service of Australia, Central Operations, Mile End, SA, Australia
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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