Physical Realism of Simulation Training for Health Care in Low- and Middle-Income Countries—A Systematic Review

Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · 2024-01-01 · 4 citations

ABSTRACT: This systematic review was conducted, according to PRISMA standards, to examine the impact of the level of physical realism of simulation training on clinical, educational, and procedural outcomes in low- and middle-income countries (LMICs) as defined by the World Bank. A search from January 1, 2011 to January 24, 2023 identified 2311 studies that met the inclusion criteria including 9 randomized (n = 627) and 2 case-controlled studies (n = 159). Due to the high risk of bias and inconsistency, the certainty of evidence was very low, and heterogeneity prevented any metaanalysis. We observed limited evidence for desirable effects in participant satisfaction and confidence, but no significant difference in skills acquisition and performance in the clinical practice environment. When considering the equivocal evidence and cost implications, we recommend the use of lower physical realism simulation training in LMIC settings. It is important to standardize outcomes and conduct more studies in lower income settings.

Evaluating the Implementation of the Pediatric Acute Care Education (PACE) Program in Northwestern Tanzania: A Mixed-Methods Study Guided by Normalization Process Theory

Research Square · 2024-05-31 · 2 citations

Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains

BMJ Open · 2024-02-01 · 4 citations

INTRODUCTION: To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment. The objectives of this study were to (1) assess implementation success with use of in-person support and nudging strategy and (2) describe baseline provider knowledge and metacognition. METHODS: 6-month observational study at one zonal hospital and three health centres in Mwanza, Tanzania. To assess implementation success, we used the Reach, Efficacy, Adoption, Implementation and Maintenance framework and to describe baseline provider knowledge and metacognition we used Howell's conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity. RESULTS: aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centres. Median clinical experience was 4 years (IQR 1-9) and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD ±17%). Providers averaged 78% (SD ±31%) completion of initial learning and 7% (SD ±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% (IQR: 38%-63%), unconscious-incompetence 32% (IQR: 23%-42%), conscious-incompetence 7% (IQR: 2%-15%), and unconscious-competence 2% (IQR: 0%-3%). Higher baseline conscious-competence (OR 31.6 (95% CI 5.8 to 183.5)) and being a nursing officer (aOR: 5.6 (95% CI 1.8 to 18.1)), compared with medical officer, were associated with initial learning completion or persistent activity. CONCLUSION: aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalisation is needed.

Evaluating the implementation of the Pediatric Acute Care Education (PACE) program in northwestern Tanzania: a mixed-methods study guided by normalization process theory

BMC Health Services Research · 2024-09-13 · 1 citations

BACKGROUND: In low- and middle-income countries (LMICs), such as Tanzania, the competency of healthcare providers critically influences the quality of pediatric care. To address this issue, we introduced Pediatric Acute Care Education (PACE), an adaptive learning program to enhance provider competency in Tanzania's guidelines for managing seriously ill children. Adaptive learning is a promising alternative to current in-service education, yet optimal implementation strategies in LMIC settings are unknown. OBJECTIVES: (1) To evaluate the initial PACE implementation in Mwanza, Tanzania, using the construct of normalization process theory (NPT); (2) To provide insights into its feasibility, acceptability, and scalability potential. METHODS: Mixed-methods study involving healthcare providers at three facilities. Quantitative data was collected using the Normalization MeAsure Development (NoMAD) questionnaire, while qualitative data was gathered through in-depth interviews (IDIs) and focus groups discussions (FGDs). RESULTS: Eighty-two healthcare providers completed the NoMAD survey. Additionally, 24 senior providers participated in IDIs, and 79 junior providers participated in FGDs. Coherence and cognitive participation were high, demonstrating that PACE is well understood and resonates with existing healthcare goals. Providers expressed a willingness to integrate PACE into their practices, distinguishing it from existing educational methods. However, challenges related to resources and infrastructure, particularly those affecting collective action, were noted. Early indicators point toward the potential for long-term sustainability of the PACE, but assessment of reflexive monitoring was limited due to the study's focus on PACE's initial implementation. CONCLUSION: This study offers vital insights into the feasibility and acceptability of implementing PACE in a Tanzanian context. While PACE aligns well with healthcare objectives, addressing resource and infrastructure challenges as well as conducting a longer-term study to assess reflexive monitoring is crucial for its successful implementation. Furthermore, the study underscores the value of the NPT as a framework for guiding implementation processes, with broader implications for implementation science and pediatric acute care in LMICs.

Development of pediatric acute care education (PACE): An adaptive electronic learning (e-learning) environment for healthcare providers in Tanzania

Digital Health · 2023-01-01 · 7 citations

Globally, inadequate healthcare provider (HCP) proficiency with evidence-based guidelines contributes to millions of newborn, infant, and child deaths each year. HCP guideline proficiency would improve patient outcomes. Conventional (in person) HCP in-service education is limited in 4 ways: reach, scalability, adaptability, and the ability to contextualize. Adaptive e-learning environments (AEE), a subdomain of e-learning, incorporate artificial intelligence technology to create a unique cognitive model of each HCP to improve education effectiveness. AEEs that use existing internet access and personal mobile devices may overcome limits of conventional education. This paper provides an overview of the development of our AEE HCP in-service education, Pediatric Acute Care Education (PACE). PACE uses an innovative approach to address HCPs' proficiency in evidence-based guidelines for care of newborns, infants, and children. PACE is novel in 2 ways: 1) its patient-centric approach using clinical audit data or frontline provider input to determine content and 2) its ability to incorporate refresher learning over time to solidify knowledge gains. We describe PACE's integration into the Pediatric Association of Tanzania's (PAT) Clinical Learning Network (CLN), a multifaceted intervention to improve facility-based care along a single referral chain. Using principles of co-design, stakeholder meetings modified PACE's characteristics and optimized integration with CLN. We plan to use three-phase, mixed-methods, implementation process. Phase I will examine the feasibility of PACE and refine its components and protocol. Lessons gained from this initial phase will guide the design of Phase II proof of concept studies which will generate insights into the appropriate empirical framework for (Phase III) implementation at scale to examine effectiveness.

Feasibility of an Adaptive E-Learning Environment to Improve Provider Proficiency in Essential and Sick Newborn Care in Mwanza, Tanzania

medRxiv · 2023-07-13 · 2 citations

ABSTRACT Introduction To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment (AEE). The objectives of this study were to 1) assess implementation success with use of in-person support and nudging strategy and 2) describe baseline provider knowledge and metacognition. Methods 6-month observational study at 1 zonal hospital and 3 health centers in Mwanza, Tanzania. To assess implementation success, we used the RE-AIM framework and to describe baseline provider knowledge and metacognition we used Howell’s conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity. Results aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing, and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centers. Median clinical experience was 4 years [IQR 1,9] and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD±17%). Providers averaged 78% (SD±31%) completion of initial learning and 7%(SD±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% [IQR:38-63%], unconscious-incompetence 32% [IQR:23-42%], conscious-incompetence 7% [IQR:2-15%], and unconscious-competence 2% [IQR:0-3%]. Higher baseline conscious-competence (OR 31.6 [95%CI:5.8, 183.5) and being a nursing officer (aOR: 5.6 [95%CI:1.8, 18.1]), compared to medical officer) were associated with initial learning completion or persistent activity. Conclusion aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning, and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalization is needed. Key questions What is already known on this topic . Summarize the state of scientific knowledge on this subject before you did your study and why this study needed to be done . - In sub-Saharan Africa, gaps in care quality may contribute to its high neonatal mortality. - Provider knowledge is a main driver of care quality, but current conventional in-service education methods are inadequate in adaptivity, reach, effectiveness, and refresher assignments. - Hard copies of national guidelines have been disseminated to health facilities expectations are HCPs will learn and adhere to them. - Adaptive eLearning, a subdomain of e-learning, holds the potential to overcome limitations to in-service medical education, but the optimal implementation strategy is unknown. What this study adds . Summarize what we now know because of this study that we did not know before . - Baseline knowledge of essential and sick newborn care was low, mostly due to unconscious incompetence (providers thinking they were correct when they were incorrect). - Initial learning completion increased significantly with the use of an in-person program manager and an escalating nudging strategy, and technical issues were not identified as a significant limitation to participation. How this study might affect research, practice, or policy . Summarize the implications of this study . - Provider self-reporting may underestimate knowledge gaps as most gaps are not known by providers. - Adaptive e-learning may be a feasible and acceptable way to disseminate guideline and improve quality of care if an implementation strategy can be identified to increase refresher assignment completion. - Once the ideal implementation strategy is identified, effectiveness of adaptive e-learning at scale can be evaluated.

A Coaxial Pulsed Plasma Thruster Model with Efficient Flyback Converter Approaches for Small Satellites

Aerospace · 2023-06-05 · 10 citations

Pulsed plasma thrusters (PPT) have demonstrated enormous potential since the 1960s. One major shortcoming is their low thrust efficiency, typically <30%. Most of these losses are due to joule heating, while some can be attributed to poor efficiency of the power processing units (PPUs). We model PPTs to improve their efficiency, by exploring the use of power electronic topologies to enhance the power conversion efficiency from the DC source to the thruster head. Different control approaches are considered, starting off with the basic approach of a fixed frequency flyback converter. Then, the more advanced critical conduction mode (CrCM) flyback, as well as other optimized solutions using commercial off-the-shelf (COTS) components, are presented. Variations of these flyback converters are studied under different control regimes, such as zero voltage switching (ZVS), valley voltage switching (VVS), and hard switched, to enhance the performance and efficiency of the PPU. We compare the max voltage, charge time, and the overall power conversion efficiency for different operating regimes. Our analytical results show that a more dynamic control regime can result in fewer losses and enhanced performance, offering an improved power conversion efficiency for PPUs used with PPTs. An efficiency of 86% was achieved using the variable frequency approach. This work has narrowed the possible PPU options through analytical analysis and has therefore identified a strategic approach for future investigations. In addition, a new low-power coaxial micro-thruster model using equivalent circuit model elements is developed.This is referred to as the Carlow–Stuttgart model and has been validated against experimental data from vacuum chamber tests in Stuttgart’s Pulsed Plasma Laboratory. This work serves as a valuable precursor towards the implementation of highly optimized PPU designs for efficient PPT thrusters for the next PETRUS (pulsed electrothermal thruster for the University of Stuttgart) missions.

862: FEASIBILITY TRIAL OF ADAPTIVE ELECTRONIC LEARNING FOR PEDIATRIC HEALTHCARE WORKERS IN TANZANIA

Critical Care Medicine · 2022-12-15 · 2 citations

Smith, Zachary; Hokororo, Adolfine; Masenge, Theopista; Mwanga, Joseph; Kalabamu, Salvatory; Berg, Marc; Rozenfeld, Boris; Xwatsal, Elias; Pastory, Noel; Msoke, Idi; Ndosi, Hanston; Chami, Neema; Mkopi, Namala; Mwanga, Castory; Agweyu, Ambrose; Meaney, Peter Author Information

Pediatric timing of epinephrine doses: A systematic review

Resuscitation · 2021-01-30 · 17 citations

Improved survival to hospital discharge in pediatric in-hospital cardiac arrest using 2 Joules/kilogram as first defibrillation dose for initial pulseless ventricular arrhythmia

Resuscitation · 2020-06-06 · 23 citations