Efficacy of a Standardized Computer-Based Training Curriculum to Teach Echocardiographic Identification of Rheumatic Heart Disease to Nonexpert Users - 12/05/16
, Bruno R. Nascimento, MD, MSc, PhD b, c, Adriana C. Diamantino, MD c, Gabriel T.R. Pereira, MD b, Eduardo L.V. Lopes, MD b, Cassio O. Miri, PhD c, Kaciane K.O. Bruno, MSN c, Graziela Chequer, MD, MSc, PhD b, c, Camila G. Ferreira, BSN c, Luciana C.X. Lafeta, BSN c, Hedda Richards, RDCS a, Lindsay Perlman, MPh a, Catherine L. Webb, MD d, Antonio L.P. Ribeiro, MD, PhD b, c, Craig Sable, MD a, Maria do Carmo P. Nunes, MD, PhD b, cAbstract |
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.
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| The Verizon, Basking Ridge, New Jersey through the Programa de Rastreamento da Valvopatia Reumática (PROVAR) program supported this work and General Electric provided the echocardiography equipment used for study completion. The sponsors did not have any involvement in study design, data collection, data analysis, writing of the manuscript, or decision to submit this article for publication. |
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| See page 1788 for disclosure information. |
Vol 117 - N° 11
P. 1783-1789 - juin 2016 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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