Efficacy of a Standardized Computer-Based Training Curriculum to Teach Echocardiographic Identification of Rheumatic Heart Disease to Nonexpert Users
| Autor: | Catherine L. Webb, Kaciane K Bruno, Lindsay Perlman, Andrea Beaton, Bruno Ramos Nascimento, Maria do Carmo Pereira Nunes, Antonio Luiz Pinho Ribeiro, Graziela Chequer, Eduardo L.V. Lopes, Luciana C Lafeta, Hedda Richards, Gabriel Tensol Rodrigues Pereira, Cassio O Miri, Camila G Ferreira, Adriana C. Diamantino, Craig Sable |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Heart disease Point-of-Care Systems Point-of-care testing Cardiology 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine Task Performance and Analysis medicine Humans Medical physics 030212 general & internal medicine Child Psychiatry Curriculum Training curriculum Internet business.industry Rheumatic Heart Disease Computer based medicine.disease Test (assessment) Identification (information) Echocardiography Point-of-Care Testing Child Preschool Workforce Education Medical Continuing Female Clinical Competence Cardiology and Cardiovascular Medicine business Brazil |
| Zdroj: | The American Journal of Cardiology. 117:1783-1789 |
| ISSN: | 0002-9149 |
| DOI: | 10.1016/j.amjcard.2016.03.006 |
| Popis: | The ability to integrate echocardiographic for rheumatic heart disease (RHD) into RHD prevention programs is limited because of lack of financial and expert human resources in endemic areas. Task shifting to nonexperts is promising; but investigations into workforce composition and training schemes are needed. The objective of this study was to test nonexperts' ability to interpret RHD screening echocardiograms after a brief, standardized, computer-based training course. Six nonexperts completed a 3-week curriculum on image interpretation. Participant performance was tested in a school-screening environment in comparison to the reference approach (cardiologists, standard portable echocardiography machines, and 2012 World Heart Federation criteria). All participants successfully completed the curriculum, and feedback was universally positive. Screening was performed in 1,381 children (5 to 18 years, 60% female), with 397 (47 borderline RHD, 6 definite RHD, 336 normal, and 8 other) referred for handheld echo. Overall sensitivity of the simplified approach was 83% (95% CI 76% to 89%), with an overall specificity of 85% (95% CI 82% to 87%). The most common reasons for false-negative screens (n = 16) were missed mitral regurgitation (MR; 44%) and MR ≤1.5 cm (29%). The most common reasons for false-positive screens (n = 179) included identification of erroneous color jets (25%), incorrect MR measurement (24%), and appropriate application of simplified guidelines (39.4%). In conclusion, a short, independent computer-based curriculum can be successfully used to train a heterogeneous group of nonexperts to interpret RHD screening echocardiograms. This approach helps address prohibitive financial and workforce barriers to widespread RHD screening. |
| Databáze: | OpenAIRE |
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