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Horiuchi S, Soller T, Bykersma C, Huang S, Smith R, Vogel JP. Use of digital technologies for staff education and training programmes on newborn resuscitation and complication management: a scoping review. BMJ Paediatr Open 2024; 8:e002105. [PMID: 38754893 PMCID: PMC11097833 DOI: 10.1136/bmjpo-2023-002105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 04/09/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Poor-quality care is linked to higher rates of neonatal mortality in low-income and middle-income countries (LMICs). Limited educational and upskilling opportunities for healthcare professionals, particularly those who work in remote areas, are key barriers to providing quality neonatal care. Novel digital technologies, including mobile applications and virtual reality, can help bridge this gap. This scoping review aims to identify, analyse and compare available digital technologies for staff education and training to improve newborn care. METHODS We conducted a structured search of seven databases (MEDLINE (Ovid), EMBASE (Ovid), EMCARE (Ovid), Global Health (CABI), CINAHL (EBSCO), Global Index Medicus (WHO) and Cochrane Central Register of Controlled Trials on 1 June 2023. Eligible studies were those that aimed to improve healthcare providers' competency in newborn resuscitation and management of sepsis or respiratory distress during the early postnatal period. Studies published in English from 1 January 2000 onwards were included. Data were extracted using a predefined data extraction format. RESULTS The review identified 93 eligible studies, of which 35 were conducted in LMICs. E-learning platforms and mobile applications were common technologies used in LMICs for neonatal resuscitation training. Digital technologies were generally well accepted by trainees. Few studies reported on the long-term effects of these tools on healthcare providers' education or on neonatal health outcomes. Limited studies reported on costs and other necessary resources to maintain the educational intervention. CONCLUSIONS Lower-cost digital methods such as mobile applications, simulation games and/or mobile mentoring that engage healthcare providers in continuous skills practice are feasible methods for improving neonatal resuscitation skills in LMICs. To further consider the use of these digital technologies in resource-limited settings, assessments of the resources to sustain the intervention and the effectiveness of the digital technologies on long-term health provider performance and neonatal health outcomes are required.
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Affiliation(s)
- Sayaka Horiuchi
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Environmental Medicine, University of Yamanashi Graduate School of Medicine, Chuo, Yamanashi, Japan
| | - Tasmyn Soller
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Chloe Bykersma
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Shan Huang
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Rachel Smith
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
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Marceau M, Vachon Lachiver É, Lambert D, Daoust J, Dion V, Langlois MF, McConnell M, Thomas A, St-Onge C. Assessment Practices in Continuing Professional Development Activities in Health Professions: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 44:81-89. [PMID: 37490015 DOI: 10.1097/ceh.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
INTRODUCTION In continuing professional development (CPD), educators face the need to develop and implement innovative assessment strategies to adhere to accreditation standards and support lifelong learning. However, little is known about the development and validation of these assessment practices. We aimed to document the breadth and depth of what is known about the development and implementation of assessment practices within CPD activities. METHODS We conducted a scoping review using the framework proposed by Arksey and O'Malley (2005) and updated in 2020. We examined five databases and identified 1733 abstracts. Two team members screened titles and abstracts for inclusion/exclusion. After data extraction, we conducted a descriptive analysis of quantitative data and a thematic analysis of qualitative data. RESULTS A total of 130 studies were retained for the full review. Most reported assessments are written assessments (n = 100), such as multiple-choice items (n = 79). In 99 studies, authors developed an assessment for research purpose rather than for the CPD activity itself. The assessment validation process was detailed in 105 articles. In most cases, the authors examined the content with experts (n = 57) or pilot-tested the assessment (n = 50). We identified three themes: 1-satisfaction with assessment choices; 2-difficulties experienced during the administration of the assessment; and 3-complexity of the validation process. DISCUSSION Building on the adage "assessment drives learning," it is imperative that the CPD practices contribute to the intended learning and limit the unintended negative consequences of assessment. Our results suggest that validation processes must be considered and adapted within CPD contexts.
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Affiliation(s)
- Mélanie Marceau
- Dr. Marceau: Assistant Professor, School of Nursing, Université de Sherbrooke, Sherbrooke, Québec, Canada. Ms. Vachon Lachiver: PhD Candidate in research in Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada. Ms. Lambert: Student, Université du Québec en Outatouais, Gatineau, Québec, Canada. Ms. Daoust: Student at Ontario College of Traditional Chinese Medicine, Toronto, Ontario, Canada. Mr. Dion: Undergraduate Medical Student, Université de Sherbrooke, Sherbrooke, Québec, Canada. Dr. Langlois: Full Professor, Department of Medicine and Continuing Professional Development Office, Université de Sherbrooke, Sherbrooke, Québec, Canada. Dr. McConnell: Associate Professor, Department of Innovation in Medical Education, Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr. Thomas: Associate Professor, School of Physical and Occupational Therapy, Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada. Dr. St-Onge: Full Professor, Department of Medicine and Health Sciences Pedagogy Center, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Khan N, Crehan C, Hull-Bailey T, Normand C, Larsson L, Nkhoma D, Chiyaka T, Fitzgerald F, Kesler E, Gannon H, Kostkova P, Wilson E, Giaccone M, Krige D, Baradza M, Silksmith D, Neal S, Chimhuya S, Chiume M, Sassoon Y, Heys M. Software development process of Neotree - a data capture and decision support system to improve newborn healthcare in low-resource settings. Wellcome Open Res 2022; 7:305. [PMID: 38022734 PMCID: PMC10682609 DOI: 10.12688/wellcomeopenres.18423.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/01/2023] Open
Abstract
The global priority of improving neonatal survival could be tackled through the universal implementation of cost-effective maternal and newborn health interventions. Despite 90% of neonatal deaths occurring in low-resource settings, very few evidence-based digital health interventions exist to assist healthcare professionals in clinical decision-making in these settings. To bridge this gap, Neotree was co-developed through an iterative, user-centered design approach in collaboration with healthcare professionals in the UK, Bangladesh, Malawi, and Zimbabwe. It addresses a broad range of neonatal clinical diagnoses and healthcare indicators as opposed to being limited to specific conditions and follows national and international guidelines for newborn care. This digital health intervention includes a mobile application (app) which is designed to be used by healthcare professionals at the bedside. The app enables real-time data capture and provides education in newborn care and clinical decision support via integrated clinical management algorithms. Comprehensive routine patient data are prospectively collected regarding each newborn, as well as maternal data and blood test results, which are used to inform clinical decision making at the bedside. Data dashboards provide healthcare professionals and hospital management a near real-time overview of patient statistics that can be used for healthcare quality improvement purposes. To enable this workflow, the Neotree web editor allows fine-grained customization of the mobile app. The data pipeline manages data flow from the app to secure databases and then to the dashboard. Implemented in three hospitals in two countries so far, Neotree has captured routine data and supported the care of over 21,000 babies and has been used by over 450 healthcare professionals. All code and documentation are open source, allowing adoption and adaptation by clinicians, researchers, and developers.
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Affiliation(s)
- Nushrat Khan
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Caroline Crehan
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | | | | | - Leyla Larsson
- Biomedical Research and Training Institute (BRTI), Harare, Zimbabwe
| | | | - Tarisai Chiyaka
- Biomedical Research and Training Institute (BRTI), Harare, Zimbabwe
| | | | - Erin Kesler
- Children's Hospital of Philadelphia, Philadelphia, USA
| | - Hannah Gannon
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Patty Kostkova
- UCL Centre for Digital Public Health in Emergencies, London, UK
| | - Emma Wilson
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | | | - Danie Krige
- Baobab Web Services, City of Cape Town, South Africa
| | | | | | - Samuel Neal
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | | | | | | | - Michelle Heys
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
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Messersmith LJ, Ladha A, Kolhe C, Patel A, Summers JS, Rao SR, Das P, Mohammady M, Conant E, Ramanathan N, Hibberd PL. Poor power quality is a major barrier to providing optimal care in special neonatal care units (SNCU) in Central India. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13479.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Approximately 25% of all neonatal deaths worldwide occur in India. The Indian Government has established Special Neonatal Care Units (SNCUs) in district and sub-district level hospitals to reduce neonatal mortality, but mortality rates have stagnated. Reasons include lack of personnel and training and sub-optimal quality of care. The role of medical equipment is critical for the care of babies, but its role in improving neonatal outcomes has not been well studied. Methods: In a qualitative study, we conducted seven focus group discussions with SNCU nurses and pediatric residents and thirty-five key informant interviews and with pediatricians, residents, nurses, annual equipment maintenance contractors, equipment manufacturers, and Ministry of Health personnel in Maharashtra between December 2019 and November 2020. The goal of the study was to understand challenges to SNCU care. In this paper, we focus on current gaps and future needs for SNCU equipment, quality of the power supply, and use of SNCU equipment. Results: Respondents described a range of issues but highlighted poor power quality as an important cause of equipment malfunction. Other concerns were lack of timely repair that resulted in needed equipment being unavailable for neonatal care. Participants recommended procuring uninterrupted power supply (UPS) to protect equipment, improving quality/durability of equipment to withstand constant use, ensuring regular proactive maintenance for SNCU equipment, and conducting local power audits to discern and address the causes of power fluctuations. Conclusions: Poor power quality and its negative impact on equipment function are major unaddressed concerns of those responsible for the care and safety of babies in SNCUs in Central India. Further research on the power supply and protection of neonatal equipment is needed to determine a cost-effective way to improve access to supportive care in SNCUs and desired improvements in neonatal mortality rates.
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Kayastha R, Mueller S, Yadav P, Kelman I, Boscor A, Saville N, Arjyal A, Baral S, Fordham M, Hearn G, Kostkova P. Do Women in Nepal Like Playing a Mobile Game? MANTRA: A Mobile Gamified App for Improving Healthcare Seeking Behavior in Rural Nepal. Front Public Health 2021; 9:645837. [PMID: 34805057 PMCID: PMC8603420 DOI: 10.3389/fpubh.2021.645837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
In Low and Middle Income Countries (LMIC), one of the causes of maternal and child mortality is a lack of medical knowledge and consequently the inability to seek timely healthcare. Mobile health (mHealth) technology is gradually becoming a universal intervention platform across the globe due to ubiquity of mobile phones and network coverage. MANTRA is a novel mHealth intervention developed to tackle maternal and child health issues through a serious mobile game app in rural Nepal, which demonstrated a statistically significant knowledge improvement in rural women. This paper explores the perceptions and usability of the MANTRA app amongst rural women and Female Community Health Volunteers (FCHVs) in Nepal. Despite the challenges of a target user group with limited educational levels and low smartphone experience, all participants viewed the MANTRA app with approval and enthusiasm. They were willing to engage further with the mHealth intervention and to share their experience and knowledge with fellow community members. Participants also showed an increase in awareness of danger signs enabling them to make better informed health decisions in the future. FCHVs viewed the app as a validation tool providing and support for greater impact of their efforts in rural Nepal. Growing mobile ownership, network coverage and availability of smartphones along with acceptance of the prototype MANTRA app in rural communities suggest encouraging prospects for mHealth interventions to be incorporated in the national health infrastructure in Nepal and other LMICs.
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Affiliation(s)
- Rachya Kayastha
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Sonja Mueller
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
| | - Punam Yadav
- Centre for Gender and Disaster, Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
| | - Ilan Kelman
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Andrei Boscor
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
| | - Naomi Saville
- Institute for Global Health, University College London, London, United Kingdom
| | - Abriti Arjyal
- Health Research and Social Development Forum (HERD International), Kathmandu, Nepal
| | - Sushil Baral
- Health Research and Social Development Forum (HERD International), Kathmandu, Nepal
| | | | - Gareth Hearn
- Centre for Gender and Disaster, Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
| | - Patty Kostkova
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
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Dissemination of Best Practices in Preterm Care Through a Novel Mobile Phone-Based Interactive e-Learning Platform. Indian J Pediatr 2021; 88:1068-1074. [PMID: 33682022 DOI: 10.1007/s12098-021-03689-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe an innovative interactive e-learning method to disseminate knowledge to larger group of participants over a wide geographical area. METHODS The course material included standard training tool "Best Practices in Preterm Care," hosted on Telegram, a cloud-based instant messaging platform. The participants were enrolled in the group created on Telegram by the facilitators and included in-service nurses from India, Bhutan, Bangladesh, and UAE. They were mentored by 62 facilitators over 10 wk. Content of each module was loaded every week on two specific days. Mentors specified for that week facilitated learning through discussions. There was a live session every week to address any additional queries and to summarize the key messages of the week. Each week ended with weekly assessments through quiz. RESULTS In this course, 4623 nursing professionals from India and Southeast Asian Region involved in providing neonatal care, participated. There were 9939 posts with an average of 126 posts per day. Majority of the participants felt that the topics were relevant (~95%) and they were comfortable in asking questions and could clarify their doubts (~90%). Majority rated their overall experience as very good to excellent (~98%). CONCLUSIONS Interactive e-learning using the current approach if channelized optimally seems to be acceptable and feasible method to reach wide geographical area. This, however, needs local champions ready to mentor their own health professionals with context-specific guidance.
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Chan NHM, Merali HS, Mistry N, Kealey R, Campbell DM, Morris SK, Data S. Development of a novel mobile application, HBB Prompt, with human factors and user-centred design for Helping Babies Breathe skills retention in Uganda. BMC Med Inform Decis Mak 2021; 21:39. [PMID: 33541340 PMCID: PMC7863544 DOI: 10.1186/s12911-021-01406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Helping Babies Breathe (HBB) is a life-saving program that has helped reduce neonatal morbidity and mortality, but knowledge and skills retention after training remains a significant challenge for sustainability of impact. User-centred design (UCD) can be used to develop solutions to target knowledge and skills maintenance. METHODS We applied a process of UCD beginning with understanding the facilitators of, and barriers to, learning and retaining HBB knowledge and skills. HBB Master Trainers and frontline HBB providers participated in a series of focus group discussions (FGDs) to uncover the processes of skills acquisition and maintenance to develop a mobile application called "HBB Prompt". Themes derived from each FGD were identified and implications for development of the HBB Prompt app were explored, including feasibility of incorporating strategies into the format of an app. Data analysis took place after each iteration in Phase 1 to incorporate feedback and improve subsequent versions of HBB Prompt. RESULTS Six HBB trainers and seven frontline HBB providers participated in a series of FGDs in Phase 1 of this study. Common themes included lack of motivation to practise, improving confidence in ventilation skills, ability to achieve the Golden Minute, fear of forgetting knowledge or skills, importance of feedback, and peer-to-peer learning. Themes identified that were not feasible to address pertained to health system challenges. Feedback about HBB Prompt was generally positive. Based on initial and iterative feedback, HBB Prompt was created with four primary functions: Training Mode, Simulation Mode, Quizzes, and Dashboard/Scoreboard. CONCLUSIONS Developing HBB Prompt with UCD to help improve knowledge and skills retention was feasible and revealed key concepts, including drivers for successes and challenges faced for learning and maintaining HBB skills. HBB Prompt will be piloted in Phase 2 of this study, where knowledge and skills retention after HBB training will be compared between an intervention group with HBB Prompt and a control group without the app. Trial registration Clinicaltrials.gov (NCT03577054). Retrospectively registered July 5, 2018, https://clinicaltrials.gov/ct2/show/study/NCT03577054 .
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Affiliation(s)
- Natalie Hoi-Man Chan
- Division of Neonatology, British Columbia Women’s Hospital, 1N55-4480 Oak Street, Vancouver, BC V6H 3V4 Canada
| | - Hasan S. Merali
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children’s Hospital, 1280 Main Street West, HSC-2R104, Hamilton, ON L8S 4K1 Canada
| | - Niraj Mistry
- Division of Paediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ryan Kealey
- Interactive Media Lab, University of Toronto, 5 King’s College Road, Toronto, ON M5S 3G8 Canada
- Design Research, TD Bank Group, Toronto, ON Canada
| | - Douglas M. Campbell
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON Canada
- Neonatal Intensive Care Unit, St. Michael’s Hospital, 15014 - 30 Bond St, Toronto, M5B 1W8 ON Canada
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Shaun K. Morris
- Division of Infectious Diseases and Centre for Global Child Health, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
- Consortium for Affordable Medical Technologies in Uganda (CAMTech Uganda), Mbarara, Uganda
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Chawla D, Thukral A, Kumar P, Deorari A. Harnessing mobile technology to deliver evidence-based maternal-infant care. Semin Fetal Neonatal Med 2021; 26:101206. [PMID: 33612418 DOI: 10.1016/j.siny.2021.101206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
mHealth, the use of wireless and portable communication technology to improve the health status of the population, has seen widespread adoption in low- and middle-income countries. It has been used to increase awareness and knowledge of healthcare, to collect health-related data, to deliver healthcare information such as results of investigations or appointment reminders, to aid decision-making by healthcare providers, and to improve communication between various stakeholders of the health system. Developing countries face an immense challenge of periodically updating the professional knowledge of their huge pool of community and facility level healthcare workers. Nearly universal possession of mobile phones, low-cost internet data, and high growth rate of smartphones has facilitated the use of mHealth in delivering evidence-based guidelines and decision-aids to frontline healthcare workers. This review describes the current evidence on the use of mHealth educational interventions targeting maternal and neonatal healthcare providers in low- and middle-income countries. Recent efforts of the National Neonatology Forum of India in integration of mHealth for development and dissemination of clinical practice guidelines are also presented.
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Affiliation(s)
- Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India.
| | - Anu Thukral
- Divison of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Kumar
- Divison of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Deorari
- Divison of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Perlman JM, Velaphi S, Massawe A, Clarke R, Merali HS, Ersdal H. Achieving Country-Wide Scale for Helping Babies Breathe and Helping Babies Survive. Pediatrics 2020; 146:S194-S207. [PMID: 33004641 DOI: 10.1542/peds.2020-016915k] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
Helping Babies Breathe (HBB) was piloted in 2009 as a program targeted to reduce neonatal mortality (NM). The program has morphed into a suite of programs termed Helping Babies Survive that includes Essential Care for Every Baby. Since 2010, the HBB and Helping Babies Survive training programs have been taught to >850 000 providers in 80 countries. Initial HBB training is associated with a significant improvement in knowledge and skills. However, at refresher training, there is a knowledge-skill gap evident, with a falloff in skills. Accumulating evidence supports the role for frequent refresher resuscitation training in facilitating skills retention. Beyond skill acquisition, HBB has been associated with a significant reduction in early NM (<24 hours) and fresh stillbirth rates. To evaluate the large-scale impact of the growth of skilled birth attendants, we analyzed NM rates in sub-Saharan Africa (n = 11) and Nepal (as areas of growing HBB implementation). All have revealed a consistent reduction in NM at 28 days between 2009 and 2018; a mean reduction of 5.34%. The number of skilled birth attendants, an indirect measure of HBB sustained rollout, reveals significant correlation with NM, fresh stillbirth, and perinatal mortality rates, highlighting HBB's success and the need for continued efforts to train frontline providers. A novel live newborn resuscitation trainer as well as a novel app (HBB Prompt) have been developed, increasing knowledge and skills while providing simulation-based repeated practice. Ongoing challenges in sustaining resources (financial and other) for newborn programming emphasize the need for innovative implementation strategies and training tools.
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Affiliation(s)
- Jeffrey M Perlman
- Weill Cornell Medicine and New York-Presbyterian Komansky Children's Hospital, New York, New York;
| | - Sithembiso Velaphi
- Department of Pediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Augustine Massawe
- Department of Pediatrics and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Robert Clarke
- Maternal and Newborn Care, Latter-day Saint Charities Affiliate Faculty and Department of Public Health, College of Life Sciences, Brigham Young University, Provo, Utah
| | - Hasan S Merali
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Canada; and
| | - Hege Ersdal
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway
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Aldiania Carlos Balbino, Silva ANS, Queiroz MVO. El impacto de las tecnologías educativas en la formación de profesionales a cargo de la atención neonatal. REVISTA CUIDARTE 2020. [DOI: 10.15649/cuidarte.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: Se observa el avance existente en la producción de tecnologías educativas para facilitar el aprendizaje, la formación y la solución a las necesidades que surgen del proceso de trabajo de los profesionales que prestan servicios en las unidades neonatales. Objetivo: Evaluar el impacto de las tecnologías educativas utilizadas en la formación de profesionales a cargo de la atención neonatal. Materiales y métodos: Se llevó a cabo una revisión integradora de la literatura en PubMed, CINAHL, Scopus, Web of Science, ScienceDirect y LILACS en el periodo entre agosto y septiembre de 2017. Se cruzaron los descriptores de aplicaciones móviles “personal de salud, niños, recién nacidos, multimedia, aprendizaje, salud móvil, aplicaciones, neonatos y educación sanitaria” y se analizaron 12 artículos en total. Resultados: En los estudios se utilizaron diferentes tecnologías de enseñanza, desde las metodologías tradicionales hasta las metodologías activas, con la exposición de materiales educativos impresos junto con las tecnologías de la información y la comunicación. La mayoría de los estudios mostraron una mejora en el conocimiento, las habilidades y el cumplimiento de las directrices relacionadas con el cuidado crítico del recién nacido. Discusión: Las tecnologías educativas de corta y mediana duración que se emplearon para la atención neonatal permitieron ampliar los conocimientos y las habilidades profesionales. Las tecnologías impresas favorecieron el desarrollo de un enfoque comunicativo horizontal, lo que repercutió en el empoderamiento y la autonomía de los participantes. Los dispositivos móviles, por su parte, brindaron un apoyo inmediato al cuidador mediante el acceso a una gran diversidad de contenidos educativos desde cualquier lugar, lo que ayudó a aclarar las dudas relacionadas con la aplicación de procedimientos. Conclusión: Las tecnologías educativas utilizadas en la formación de los profesionales se encuentran diversificadas y son aplicables en diferentes escenarios de la atención neonatal, lo que repercute en el aprendizaje y los resultados en materia de salud del recién nacido
Como citar este artículo: Balbino, Aldiania Carlos; Silva, Amanda Newle Sousa; Queiroz, Maria Veraci Oliveira. O impacto das tecnologias educacionais no ensino de profissionais para o cuidado neonatal. Revista Cuidarte. 2020; 11(2): e954. http://dx.doi.org/10.15649/cuidarte.954
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Henry C, Morris DE, Coleman S, Pereira A, Tamakloe C, Blanchfield P, Sharkey D. Improving newborn heart rate assessment using a simple visual timer. BMJ Paediatr Open 2020; 4:e000638. [PMID: 32420457 PMCID: PMC7223635 DOI: 10.1136/bmjpo-2020-000638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Newborn resuscitation relies on accurate heart rate (HR) assessment, which, during auscultation, is prone to error. We investigated if a 6 s visual timer (VT) could improve HR assessment accuracy during newborn simulation. DESIGN Prospective observational study of newborn healthcare professionals. SETTING Three-phase developmental approach: phase I: HR auscultation during newborn simulation using a standard clock timer (CT) or the VT; phase II: repeat phase I after using a bespoke training app (NeoRate); phase III: following the Newborn Life Support course, participants assessed random HRs using the CT or VT. MAIN OUTCOME MEASURES HR accuracy (within ±10 beats/min, correct HR category, i.e. <60, 60-100 and >100 beats/min), assessment time and error-free rates were compared. RESULTS Overall, 1974 HR assessments were performed with participants more accurate using the VT for ±10 beats/min (70% CT vs 86% VT, p<0.001) and correct HR category (78% CT vs 84% VT, p<0.01). The VT improved accuracy across all three phases. Additionally, following app training in phase II, the HR accuracy of both the CT and VT improved. The VT resulted in faster HR assessment times of 11 s (IQR 9-13) compared with the CT at 15 s (IQR 9-23, p<0.001). Error-free scenarios increased from 24% using the CT to 57% using the VT (p<0.001), with a shorter assessment time (CT 116 s (IQR 65-156) vs VT 53 s (IQR 50-64), p<0.001). CONCLUSION Using a VT to assess simulated newborn HR combined with a training app significantly improves accuracy and reduces assessment time compared with standard methods. Evaluation in the clinical setting is required to determine potential benefits.
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Affiliation(s)
- Caroline Henry
- Division of Child Health, Obstetrics and Gynaecology, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - David E Morris
- Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - Sophie Coleman
- Division of Child Health, Obstetrics and Gynaecology, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Andrea Pereira
- Division of Child Health, Obstetrics and Gynaecology, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | | | | | - Don Sharkey
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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12
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Shridhar G, Pandey A, Karmani S. Evaluation of a multimodal teaching method on essential newborn care among health providers at a tertiary care hospital. Med J Armed Forces India 2019; 75:303-307. [PMID: 31388234 DOI: 10.1016/j.mjafi.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 06/08/2018] [Indexed: 11/26/2022] Open
Abstract
Background There is an unmet need for in-service training of health providers for essential new-born care. This study evaluated the ability of a multi-modal training workshop on new-born care to improve the knowledge and skills of health providers. Methods This was an intervention based pre-and post-study on 54 students who attended a two-day workshop on essential new-born care. The teaching used self-directed learning, demonstration, videos, webinars, podcasts, group discussion, role-play and individual feedback. Knowledge was assessed by a set of 25 peer-reviewed multiple-choice questions (MCQs), both pre-and post-test and skills by 3 peer-reviewed and validated objective structured clinical examination (OSCE) stations in the post-test period. Follow-up assessment after 10 months was also done for 30 students. Results There was a significant improvement in the knowledge scores on MCQs after the workshop [16.65 ± 1.84 vs 12 ± 2.98, mean difference 4.65, 95%CI (3.85 to 5.44); p value < 0.0001]. The skill scores assessed by the OSCE were 92.35%, 83.50% and 78.86% of the expected scores respectively with a composite OSCE stations score of 83.90% of the expected score (100%). Follow-up assessment after 10 months showed a significant decline in knowledge scores, though skill scores were retained. Conclusion An essential new-born care workshop using multi-modal teaching methods resulted in an improvement in knowledge and skill scores among a diverse mix of nurses and doctors. This model of learning was acceptable and can be adapted for future training of health providers. There is a need for regular refresher training to maintain knowledge and skills.
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Affiliation(s)
- G Shridhar
- Senior Adviser (Paediatrics) & Neonatologist, Command Hospital (Western Command), Chandimandir, India
| | - Abhishek Pandey
- Classified Specialist (Paediatrics), Command Hospital (Western Command), Chandimandir, India
| | - Saurabh Karmani
- Graded Specialist (Paediatrics), Military Hospital Dehradun, India
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13
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Bolan NE, Newman SD, Nemeth LS. Technology-Based Newborn Health Learning Initiatives for Facility-Based Nurses and Midwives in Low- and Middle-Income Countries: A Scoping Review. INTERNATIONAL JOURNAL OF CHILDBIRTH 2019. [DOI: 10.1891/2156-5287.8.4.252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSEGiven high neonatal mortality in many low- and middle-income countries, addressing missed opportunities by enhancing the quality of newborn care provided by facility-based nurses and midwives is critical. This scoping review synthesizes and critiques the literature on technology-based newborn health learning initiatives. Kirkpatrick's model is used for training program evaluation.METHODSA literature review was conducted from multiple databases. Articles selected for analysis consisted of original research studies published in peer-reviewed journals from 2012 to 2017.RESULTSTwelve studies fell into two categories: (a) Simulation training in routine neonatal care and newborn resuscitation (n = 9) and (b) eLearning initiatives (n = 3). Most studies evaluated health provider's knowledge and skills before and/or after training (n = 9); fewer evaluated the effect on change in provider practice (n = 3) and/or patient health outcomes (n = 5) (Kirkpatrick levels 3–4). Few studies utilized robust study designs and validated measurement instruments.CONCLUSIONLearning approaches emphasizing simulation training and eLearning initiatives for facility-based health workers hold promise. However, existing simulation literature demonstrates that translation of knowledge gained during simulation into improved clinical outcomes in real births is variable. Additionally, the volume of peer-reviewed evidence demonstrating the potential benefit of eLearning strategies, especially in the neonatal period, is limited.
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Lall P, Rees R, Law GCY, Dunleavy G, Cotič Ž, Car J. Influences on the Implementation of Mobile Learning for Medical and Nursing Education: Qualitative Systematic Review by the Digital Health Education Collaboration. J Med Internet Res 2019; 21:e12895. [PMID: 30816847 PMCID: PMC6416537 DOI: 10.2196/12895] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/04/2019] [Accepted: 01/04/2019] [Indexed: 12/03/2022] Open
Abstract
Background In the past 5 decades, digital education has increasingly been used in health professional education. Mobile learning (mLearning), an emerging form of educational technology using mobile devices, has been used to supplement learning outcomes through enabling conversations, sharing information and knowledge with other learners, and aiding support from peers and instructors regardless of geographic distance. Objective This review aimed to synthesize findings from qualitative or mixed-methods studies to provide insight into factors facilitating or hindering implementation of mLearning strategies for medical and nursing education. Methods A systematic search was conducted across a range of databases. Studies with the following criteria were selected: examined mLearning in medical and nursing education, employed a mixed-methods or qualitative approach, and published in English after 1994. Findings were synthesized using a framework approach. Results A total of 1946 citations were screened, resulting in 47 studies being selected for inclusion. Most studies evaluated pilot mLearning interventions. The synthesis identified views on valued aspects of mobile devices in terms of efficiency and personalization but concerns over vigilance and poor device functionality; emphasis on the social aspects of technology, especially in a clinical setting; the value of interaction learning for clinical practice; mLearning as a process, including learning how to use a device; and the importance of institutional infrastructure and policies. Conclusions The portability of mobile devices can enable interactions between learners and educational material, fellow learners, and educators in the health professions. However, devices need to be incorporated institutionally, and learners and educators need additional support to fully comprehend device or app functions. The strategic support of mLearning is likely to require procedural guidance for practice settings and device training and maintenance services on campus.
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Affiliation(s)
- Priya Lall
- School of Geography, Queen Mary University of London, London, United Kingdom
| | - Rebecca Rees
- Evidence for Policy and Practice Information and Co-ordinating Centre, Social Science Research Unit, Department of Social Science, University College London Institute of Education, University College London, London, United Kingdom
| | - Gloria Chun Yi Law
- Centre of Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Gerard Dunleavy
- Centre of Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Živa Cotič
- Faculty of Social Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Josip Car
- Centre of Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
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15
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Chen H, Chai Y, Dong L, Niu W, Zhang P. Effectiveness and Appropriateness of mHealth Interventions for Maternal and Child Health: Systematic Review. JMIR Mhealth Uhealth 2018; 6:e7. [PMID: 29317380 PMCID: PMC5780618 DOI: 10.2196/mhealth.8998] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/23/2017] [Accepted: 10/29/2017] [Indexed: 12/14/2022] Open
Abstract
Background The application of mobile health (mHealth) technology in reproductive, maternal, newborn, and child health (RMNCH) is increasing worldwide. However, best practice and the most effective mHealth interventions have not been reviewed systematically. Objective A systematic review and meta-analysis of studies of mHealth interventions for RMNCH around the world were conducted to investigate their characteristics as well as the features and effectiveness of mHealth interventions. Methods Studies of mHealth interventions for RMNCH between January 2011 and December 2016 were retrieved from 6 databases (PubMed, EMBASE, Global Health, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, and Wanfang Data Knowledge Service Medium). Comparable studies were included in a random-effects meta-analysis for both exclusive breastfeeding (EBF) and antenatal checks (ANC). Descriptive analyses were conducted for mHealth studies with a range of study designs. Results Analyses of 245 studies were included, including 51 randomized controlled trials (RCTs). Results showed that there are increasing numbers of studies on mHealth interventions for RMNCH. Although 2 meta-analysis, one with 2 RCTs on EBF (odds ratio [OR] 2.03, 95% CI 1.34-3.08, I2=25%) and the other with 3 RCTs on ANC (OR 1.43, 95% CI 1.13-1.79, I2=78%), showed that mHealth interventions are more effective than usual care, almost half (43%) of RCTs showed negative or unclear results on mHealth interventions. Functions described in mHealth interventions were diverse, and the health stages covered were broad. However, single function or single stage appeared to be dominant among mHealth interventions compared with multiple functions or stages. Conclusions More rigorous evaluations are needed to draw consistent conclusions and to analyze mHealth products with multiple functions, especially those popular in the app markets.
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Affiliation(s)
- Huan Chen
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China
| | - Yanling Chai
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China.,School of Public Health, Peking University Health Science Center, Beijing, China
| | - Le Dong
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China.,School of Public Health, Hebei Medical University, Shijiazhuang, China
| | - Wenyi Niu
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Puhong Zhang
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China.,Faculty of Medicine, University of New South Wales, Sydney, Australia
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Correspondence. Indian Pediatr 2017; 54:63. [DOI: 10.1007/s13312-017-1002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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