Cross-sectional study in Madagascar demonstrates efficacy of virtual mentoring and flipped classroom modifications of neonatal resuscitation programme Helping Babies Breathe.

AIM: The Covid-19 pandemic necessitated virtual adaptation of the neonatal resuscitation programme Helping Babies Breathe (HBB). This study assessed one such virtually mentored and flipped classroom modification in Madagascar. METHODS: A cross-sectional study was performed in September 2021 and May 2022. Healthcare providers were identified by local collaborating organisations. United States-based master trainers collaborated with local trainers on virtually mentored trainings followed by independent trainings. Master trainers were available for consultation via Zoom during the virtual training. A flipped classroom modification and traditional didactic method were compared. Primary outcomes were knowledge and skill acquisition, evaluated by written assessments and objective structured clinical examinations. RESULTS: Overall, 97 providers completed the curriculum. Written assessment scores improved in both training models (traditional-74.8% vs 91.5%, p < 0.001; flipped classroom-89.7% vs 93.6%, p < 0.05). There was no significant difference among written assessment scores (92.8% vs 91.5%, p = 0.62) and significantly higher objective structured clinical examination scores (97.3% vs 89.5%, p < 0.001) for the independent training compared to the virtually mentored training. CONCLUSION: The virtually mentored HBB training was followed by a successful independent training as measured by participant knowledge and skill acquisition, supporting the efficacy of virtual dissemination.

Skill retention after traditional versus video resuscitation training in filipino nursing students

INTRODUCTION: The Philippines has a high neonatal mortality rate. Helping Babies Breathe (HBB) simulation training has been shown to reduce early neonatal mortality with a focus on initiating bag mask ventilation (BMV) within the first minute of life. The frequency and interval for refresher training to ensure competence in HBB skills is not well-described. This study was conducted to assess the retention of resuscitation skills by Filipino nursing students when refresher HBB coursework is delivered via traditional in-person instruction compared to coursework delivered via remote telecoaching (video), with time to initiate BMV as the primary outcome. METHODS: Nursing students in Mati, Philippines (n=49) were traditionally trained in HBB;validated OSCE was used to assess pre-training and post-training skills. Students were divided into 2 month, 4 month, and 6 month follow-up and further divided within these time-based groups into video (V) or traditional (T) follow-up, for a total of 6 novel groups. OSCE was administered to test skill retention at follow-up. RESULTS: No student successfully performed BMV prior to 1 minute during pre-testing;immediately post-training, 73% of students performed BMV prior to 1 minute with an average time of 57.9 seconds. Students retested at 2 months averaged of 83.7 s and students retested for the first time at 4 months averaged 90.2 s prior to BMV initiation. Students tested for a second time at 4 months, following their initial retraining at 2 months, initiated BMV at an average of 70.4 s. There was no significant difference in individual decay of time to initiation of BVM between video and traditional trainees at 4 month follow-up (p=0.77). Due to COVID-19 restrictions, 6 month follow-up was unable to be completed. CONCLUSIONS: Skill decay was evident in both groups, with time to initiate BMV increasing between assessments. However, with a single refresher training, decay declined;it is likely this trend would continue with more frequent training. The finding of no significant difference between time to BMV after video vs traditional re-training suggests that virtual training may be a reasonable alternative in the future. This may be particularly important in the current era of educational modifications necessitated by pandemic travel restrictions.

Constructing an ethical framework for priority allocation of pandemic vaccines.

BACKGROUND: Allocation of scarce resources during a pandemic extends to the allocation of vaccines when they eventually become available. We describe a framework for priority vaccine allocation that employed a cross-disciplinary approach, guided by ethical considerations and informed by local risk assessment. METHODS: Published and grey literature was reviewed, and augmented by consultation with key informants, to collate past experience, existing guidelines and emerging strategies for pandemic vaccine deployment. Identified ethical issues and decision-making processes were also included. Concurrently, simulation modelling studies estimated the likely impacts of alternative vaccine allocation approaches. Assembled evidence was presented to a workshop of national experts in pandemic preparedness, vaccine strategy, implementation and ethics. All of this evidence was then used to generate a proposed ethical framework for vaccine priorities best suited to the Australian context. FINDINGS: Published and emerging guidance for priority pandemic vaccine distribution differed widely with respect to strategic objectives, specification of target groups, and explicit discussion of ethical considerations and decision-making processes. Flexibility in response was universally emphasised, informed by real-time assessment of the pandemic impact level, and identification of disproportionately affected groups. Model outputs aided identification of vaccine approaches most likely to achieve overarching goals in pandemics of varying transmissibility and severity. Pandemic response aims deemed most relevant for an Australian framework were: creating and maintaining trust, promoting equity, and reducing harmful outcomes. INTERPRETATION: Defining clear and ethically-defendable objectives for pandemic response in context aids development of flexible and adaptive decision support frameworks and facilitates clear communication and engagement activities.