'How can nurse lecturers teach nursing when they're not doing it...'

A review of the literature on how credibility is understood and built among clinical academics

Evaluating the effectiveness of a training intervention in neonatal resuscitation in a developing country setting: establishing grounds for further rollout

Objective: To evaluate the effectiveness of an educational intervention in neonatal resuscitation in Zambia in order to establish grounds for further rollout. Design: Single case study approach using semi-structured interviews, focus groups, participant questionnaires, observation and document analysis. Setting: Lusaka including the main teaching hospital and surrounding district health centres, the school of nursing, and Livingstone. Participants: At three levels: (a)92%(n=11) trainers trained to train (Nurses, midwives, paediatricians and anaesthetists) participated in focus groups, observation and a structured questionnaire; (b)42% (n=16) staff (midwives, nurses and anaesthetists from among candidates who underwent the initial training) took part in semi-structured interviews; and (c)42% (n=27) of staff (a mixture of nurses, midwives, paediatricians, anaesthetists, and student paediatric nurses) who underwent secondary training took part in focus groups and observation. Relevant data was also collected from analysis of training records. Findings: A number of formal and informal training sessions had been delivered and more staff trained since the initial training. There was consistent evidence of knowledge increase among those who underwent secondary training as shown by pre- and post-test scores and overwhelming consensus that most of the goals set out by the trainers at the initial training had been achieved. More importantly staff reported a positive impact on clinical outcomes and a positive shift in clinical knowledge; the quality of training and content had been fundamentally maintained and the trainers demonstrated ownership of the programme moving forward. At the same time however many participants reported challenges with funding and recognition from government and professional authorities to support further rollout and clinical application. Strategies and suggestions to address these were being proactively explored. Key conclusions: the project appears to have achieved its main objectives at times beyond the targets initially set. Zambian partners have demonstrated commitment to, and ownership of, the programme and vision to reduce neonatal mortality through training and are making concerted efforts for further rollout. However relevant support from professional and governmental authority is key to further progress. Implications for the future: Trainers would benefit from support to strengthen teaching skills. Evaluation of practice in the clinical setting, mentorship and continuing Professional Development (CPD) strategies are useful considerations moving forward. Therefore it is vital that the government recognises and funds the effective rollout and application of the training programme in practice, supported by a programme of national standardisation of neonatal resuscitation

Evaluating service provision for midwifery education: a case study

Abstract In keeping with the ethos of the Higher Education Funding Council for England (HEFCE), related Key Information Sets (KIS) and National Student Survey (HEFCE 2012), the local university’s five year strategic plan 2011-15 (Strategic Plan 2011) includes at its heart investing in the student experience with a curriculum that is flexible and responsive to changes both within and outside the university, and offering a ‘high quality university experience’ through innovative methods of learning. As part of a varied array of teaching, learning and assessment facilities, the university boasts of skills lab services which increasingly provide a unique opportunity for student midwives to practice clinical skills in a safe environment which ultimately prepares them to be fit for practice at the point of registration (Nursing and Midwifery Council (NMC) 2009). However, there has not been a formal evaluation of this service to date. Purpose This study set out to evaluate the current service provided for pre-registration midwifery students in the university skills lab in order to establish current standard, provide a benchmark for future development, and contribute to the students’ learning experience. Methodology Using a case study approach, a representative convenient sample of users of the service was studied. Participants included 7 third year and 3 first year students from the pre-registration midwifery programme based on one of the two university campus sites, and 2 midwifery lecturers plus 2 skills lab support staff working across both campuses. All participants were asked about their experience of using the skills labs. Interviews were transcribed verbatim and analysed using a thematic approach and NVivo software. Student focus groups and staff one-to-one interviews were carried out, as well as observation of activity in the skills lab. Relevant document analysis was also undertaken. Findings The main themes emerging from analysis of the data include the following: both staff and students felt that there was more theory than practice in the teaching and learning activities in the skills lab; that the management of time and communication around the assessment process in the skills lab could be improved; that the quality and authenticity of equipment and facilities could be improved; that capacity issues, consisting of an interaction between student numbers, time and space management in the lab, had a negative impact on the learning experience; and that better communication amongst users overall could further improve the service. Implications Whilst some of the findings support the literature, there appears to be some new information particularly related to student perceptions of the theory - practice ratio of sessions, and capacity issues impacting on learning. The author makes several recommendations for educational institutions providing a skills lab service including the following: Educational institutions should • explore innovative teaching strategies such as the blended approach which would allow more time for students to spend on hands-on practice in the lab, • explore strategies to enhance the authenticity of the equipment to improve the students’ learning experience in the lab, • develop better communication systems and appropriate management of timetables, coupled with clear guidelines for staff-student ratios in order to address capacity issues; clear communication around assessment that takes into account individual students’ unique needs must also be ensured. Limitations The author recognises that this study was primarily based on the experience of students from one out of two university campuses admitting pre-registration midwifery students. This was due to time constraints related to the timetable for the Master’s study. It would therefore be useful to consider further research that encompasses the experience of students from both campus sites as well as addressing possible issues surrounding parity of experience across sites

Enhancing knowledge and skills through the delivery of a bespoke neonatal resuscitation training programme in a developing country

Objective: This paper presents the design, implementation and immediate outcomes of an educational intervention in neonatal resuscitation. Setting: The training programme took place in Sub-Saharan Africa. Participants 50 midwives, nurses, neonatal, paediatric doctors, and anaesthetists, who provide care during labour and birth. Interventions: The design, implementation and immediate evaluation of a training programme was based on a "train the trainer" and an outreach programme approach which was delivered over five days. All candidates received one day training in knowledge and skills for immediate care and resuscitation of the newborn. In addition, those "trained to train" attended additional sessions to observe teaching and were equipped with relevant information and material to perpetuate the training. Measurements and findings: Immediate evaluation was undertaken by comparing pre- and post-training knowledge. The total average pre-test score was 63.5% and the total average post-test score 83.8%. There was an increase in knowledge for every individual except two where knowledge remained static. Qualitative comments about the training were also obtained which were very positive. Key conclusions: The training programme was successfully implemented and has largely achieved its objectives in impacting participant knowledge and skills. Furthermore a team of trainers has been equipped with the knowledge, skills and material to cascade the training further. Overall the project had achieved its immediate objectives through the educational strategies employed

Tendances de la tuberculose pulmonaire bactériologiquement confirmée et issues thérapeutiques en République Démocratique du Congo : 2007-2017: Trends of bacteriologically confirmed pulmonary tuberculosis and treatment outcomes in Democratic Republic of the Congo: 2007-2017

Context and objective. DR Congo ranks among high burden countries for tuberculosis. However, the real incidence of the disease is unknown. The study aimed to describe the trends in the estimated incidence of the bacteriologically confirmed pulmonary TB and therapeutic outcomes of patients. Methods. A retrospective analysis of data from TB patients recorded during the period of 2007 to 2017 through all the country. Linear regtression model and z-score helped to assess the year to year variations in notification rate and treatment outcomes. Results. A total of 884,458 patients were enrolled including 820,858 new patients (NP TP+) and 63,600 with a previous TB treatment. The increase reached 28.95% during this decade. The annual average inrease was of 2, 41% +/- 3, and 28 % for NP TP+ and of 5, 7% +/-0.26 for default patients. Treatment outcome assessment included 848,163 patients among them, 789, 716 NP TP+ and 58,447 with a previous TB treatment. The success rate was 88% in the former group, of 70% in those with relapse, 64.3% in patients with failure and 67.8% in the group of ancient defaulters. A total of 70,515 (8.3%) patients remained smear positive. Conclusion. The study shows an increase in the incidence of reported TP+ patients with a treatment outcome reaching the WHO’s expectations. However the high proportion of smear positive patients suggests a high risk of further acquired TB resistance. Contexte et objectifs. La République Démocratique du Congo compte parmi les pays à lourd fardeau pour la tuberculose (TB), l’incidence réelle de la maladie n’est pas formellement connue. La présente étude vise à décrire les tendances de l’incidence notifiée des patients atteints de tuberculose pulmonaire bactériologiquement confirmée (TP+) et leurs issues thérapeutiques. Méthodes. Cette étude documentaire, analyse les données des patients diagnostiqués et traités pour tuberculose de 2007 à 2017 en RDC. L’incidence notifiée des patients TP+, le taux d’accroissement annuel, les issues thérapeutiques ont été recherchés. Les variations du nombre de patients sont exprimées par les proportions. Les tendances sont présentées à travers les courbes de régression linéaire. Les issues thérapeutiques sont comparées à l’aide du z-score avec un seuil significatif de p˂ 0,05. Résultats. Au total 884 458 patients TP+ ont été rapportés, dont 820 858 nouveaux patients (NP TP+) et 63 600 déjà traités. Le taux d’accroissement au cours de cette décade était de 28,95%, soit de 66099 en 2007 à 93767 en 2017 pour les NP TP+. L’augmentation annuelle moyenne était de 2,41% +/- 3,28 pour les NP TP+ et de 5,7% +/- 0,26 par an pour les rechutes. La notification des échecs de traitement initial et repris après abandon de traitement ont une tendance à la baisse. L’évaluation thérapeutique de tous les cas cumulés a concerné 848 163 patients dont 789 716 NP TP+ et 58447 en retraitement. Le succès thérapeutique était de 88,0 % pour les NP TP+ et 70,0 % pour les rechutes, de 64,3 % pour les échecs et de 67,8% pour les repris en traitement après abandon. En somme 70 515 (8,3%) patients ont gardé des expectorations positives. Conclusion. Cette étude montre une tendance à la hausse de notification des cas incidents dont l’issue de traitement répond aux standards de l’OMS. En outre, un nombre des personnes demeurent porteurs de germes persistants précurseurs d’une TB pharmacorésistante acquise

Assessment of treatment outcomes of multidrug-resistant tuberculosis patients in D R Congo: A study based on drug regimens used between 2007 to 2017: Évaluation des issues thérapeutiques des patients atteints de la tuberculose à bacilles multi résistants : étude basée sur les régimes de médicaments utilisés en République Démocratique du Congo de 2007 à 2017

Context. Little is known about therapeutic successes in MDR-TB patients under regimens containing second-line molecules. The present study aimed to assess therapeutic outcomes in patients under therapeutic regimens applied in DR Congo. Methods. This historical cohort study has included confirmed MDR-TB patients who received treatment between 2007 and 2017 in 218 TB centers in DR Congo. Treatment outcome and survival at 36 months were analyzed using Zscore and chi square test. Kaplan-Meier method was performed to describe survival and Log Rank test helped in comparing curve based on the therapeutical regimen. Factors associated with therapeutic success and mortality predictors were assessed using multivariate logistic regression and Cox regression analysis, respectively. Results. The therapeutic success in the study group (n=1,724) was 72% (range 68-74%) for all regimen combined. The average death rate was 12.8% although the group of patients receiving Cyclosérine and Ofloxacine was the most affected (16%). The death rate was significantly higher in patients living in urban areas (15.2% versus 14.9%, p = 0.013) and also among MDR-TB/HIV co-infected patients (28.4% vs 15.7%, p<0.001) patients. The median survival of the study group was 722.7 days compared to 601.1 days for MDR-TB/HIV co-infected patients, and 736.7 days for HIV negative patients (p<0.001). Conclusion. Therapeutic successes are significant for the short regimen. However, the death rate remains high when Cycloserine and Ofloxacin are included in the regimen. The predictors of mortality are HIV infection and living in urban areas. Contexte. L’issue thérapeutique de la tuberculose multi résistante (TB-MR) sous les molécules de deuxième intention n’est pas très bien connue. La présente étude a évalué les régimes thérapeutiques appliqués, en termes de succès thérapeutique et de survie. Méthodes. L’étude de cohorte historique a inclu les patients TB-MR confirmés et traités entre 2007 et 2017 dans 218 centres de tuberculose en RD Congo. L’issue thérapeutique et la survie à 36 mois ont été analysées. Le score Z ou le test de chi carré ont comparé des issues. La méthode de Kaplan-Meier a décrit les courbes de survie et le test de Log Rank a comparé la survie en fonction du regime therapeutique. Les facteurs associés au succès thérapeutique et les prédicteurs de mortalité ont été analysés respectivement, par l’analyse multivariée de régression logistique et de Cox. Résultats. Dans le groupe étudié (n=1724), le succès thérapeutique a été de 72% (68-74%) pour l’ensemble des régimes. Le taux était plus élevé pour le régime court (74%) et plus faible pour le régime contenant la Cyclosérine et l’Ofloxacine (68%). La moyenne de décès était de 12,8% ; mais plus élevée dans le groupe sous regime contenant la Cyclosérine et l’Ofloxacine (16%). Le taux de décès était significativement plus élevé en milieu urbain (15,2% versus 14,9 %, p = 0,013) et également chez les sujets co-infectés par la MDR-TB  et le VIH (28.4% vs 15.7%, p <0,001). La survie médiane dans le groupe était de 722,7 jours contre 601,1 jours chez les co-infectés MDR-TB/VIH, et de 736,7 jours) chez les patients VIH négatifs (p<0,001). Conclusion. Les succès thérapeutiques sont acceptables en particulier, pour le régime court ; toutefois, le taux de décès demeure encore très élevé dans le groupe sous Cyclosérine et Ofloxacine. Les prédicteurs de mortalité sont l’infection à VIH et la vie citadine. &nbsp

Exclusive Breastfeeding and Clinical Malaria Risk in 6-Month-Old Infants: A Cross-Sectional Study from Kinshasa, Democratic Republic of the Congo

The World Health Organization recommends exclusive breastfeeding (EBF) for the first 6 months of life. However, the effect of EBF on malaria risk remains unclear. In the present study, 137 EBF infants and 358 non-EBF infants from the Democratic Republic of the Congo were assessed for fever and malaria infections by polymerase chain reaction, at 6 months of age. EBF was associated with a reduced risk of clinical malaria (odds ratio = 0.13; 95% confidence interval = 0.00–0.80), suggesting a protective effect of EBF against malaria

Vitamin D Deficiency and Risk of Uterine Leiomyoma among Congolese Women. A Hospital-Based Case-Control Study

The aim of the present study was to assess the relationship, between Vitamin D deficiency and uterine leiomyoma in Congolese women.From April 1 to October 31, 2014, 216 patients with ultrasound diagnosis of uterine leiomyoma (cases) and 216 women without this condition (controls) recruited in six medical facilities in Kinshasa were enrolled in the present study. A single blood sample was obtained from all participants to assess serum17β-estradiol and progesterone concentration using RIA and 25(OH) D by IRMA. Vitamin D deficiency was defined as 25(OH) D levels <4 ng/mL and <12 ng/mL using local and IOM cut-off levels, respectively. Chi square, Student t and Mann Whitney tests were used for group comparison. Logistic regression analysis was used to identify factors associated with Vitamin D deficiency. Vitamin D deficiency was observed in 17.1% and 47.7% of patients with ULM using local and IOM criteria defining different steps of vitamin D respectively. Compared to controls, the difference was statistically significant only when using local criteria (17.7% vs 10.2%; p = 0.028).ULM main risk factors were age ≥35 years (aOR=2,974; 95%CI 1,702-5,139; p = 0,001); null parity (aOR=3,951;95%CI 2,311-6,754;  p= 0,001). Familial history of ULM (aOR=2,619; 95% CI 1,376-4,986; p =0,003) personal history of ULM a(OR3,776; 95% CI 1,885-7,565;  p=0,001); absence of menopause(OR5,502; 95% CI 2,615-11,517; p= 0,001); high serum progesterone levels (aOR 2,320 95% CI1,136-4,711; p= 0,021),   alcohol consumption  (aOR0,295; 95 % CI 0,150-0,580; p= 0,001) and Vitamin D deficiency(aOR2,153; 95% CI 1,035-4,517; p=  0,040).  Vitamin D deficiency was a common finding in patients with ULM and emerged as one of the main risk factors. However, this relationship need to be confirmed with a representative sample of women with ULM

Bcl2, Bax and LMP1 Genes Expression in Uterine Leiomyoma Tissue According to Vitamin D Status among Congolese Women

The objective of this paper is to describe genes expression patterns of the anti-apoptotic Bcl2 and pro apoptotic Bax as well as EBV infection marker LMP1 in, leiomyoma tissue according to patients vitamin D status. To investigate the relationship between alterations of genes expression patterns and serum vitamin D levels, samples from 105 women undergoing surgery for uterine leiomyoma in 6 hospitals in Kinshasa from April 1 to October 31, 2014 were obtained for genes expression analysis of Bcl-2, Bax and LMP-1 genes. Genes expression in leiomyomas was measured by immunohistochemistry. Serum vitamin D levels were determined by IRMA. Association between vitamin D status and genes expression was assessed using logistic regression analysis. From 105 women providers of leiomyoma tissues examined, 41 were sufficients in vitamin D, 36 were insufficients and 28 deficients. In uterine leiomyoma tissues obtained Bcl2 was expressed in 96 (91.4%) of samples with low, moderate and high expression observed in 33.3%, 32.4% and 25.7%, respectively. The differences in Bcl2 expression between the three subgroups of vitamin D categories were not statistically significant.As a mirror of Bcl2 expression, Bax protein was not expressed in the majority (n = 95, 90.5%) of samples. Similar to Bcl2, the differences in Bax expression between the three subgroups of vitamin D categories did not reach the level of statistical significance. Of the 105 leiomyoma tissue examined, LMP1 was observed in 30 (28.6%) of samples and showed a tendency towards increased expression with the decline in vitamin D levels; however, the tendency was fairly not statistically significant.In multivariate analysis, predictors of Bcl2 expression were age, parity, and overweight/obesity and insufficiency/deficiency vitamin D; however, the differences observed were not statistically significant. The same predictors were also associated with Bax expression but once again the observed differences were not statistically significant. Vitamin D deficiency, the only predictor significantly associated with LMP1 expression, conferred a 3.9 fold greater risk (aOR 3.9; 95% CI 1.068-14.242; p = 0.039) of expressing LMP1 in leiomyoma tissue.In the present study, Bcl2 gene expression in ULM tissues tended to increase with the decline in vitamin D levels but observed differences were not statistically significant. In contrast, LMP1 gene expression was significantly associated with vitamin D deficiency. In spite of methodological limits, these findings do suggest a role of Vitamin D deficiency in the development and progression of ULM