Andrew Penn

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

BACKGROUND Scaling-up improved management of severe acute malnutrition has been identified as the nutrition intervention with the largest potential to reduce child mortality but lack of operational capacity at all levels of the health system constrains scale-up. We therefore developed an interactive Malnutrition eLearning course that is accessible at scale to build capacity of the health sector workforce to manage severely malnourished children according to guidelines of the World Health Organization (WHO). OBJECTIVE The study aim was to test whether the Malnutrition eLearning course improves knowledge and skills of in-service and pre-service health professionals in managing children with severe acute malnutrition. METHODS This 2-year prospective, longitudinal, empirical research study took place in Ghana, Guatemala, El Salvador and Colombia between January 2015 and February 2017. A subset of 354 in-service health personnel from 12 hospitals and 2 Ministries of Health, 703 pre-service trainees from 9 academic institutions, and 204 online users participated. Knowledge gain after training and retention over time were measured through pre- and post-assessments, comprising questions pertaining to screening, diagnosis, pathophysiology, and treatment and prevention of malnutrition. Comprehension, application and integration of knowledge were tested. Changes in perception, confidence, and clinical practice were assessed through questionnaires and interviews. RESULTS Before the course, awareness of the WHO guidelines was 36.7% (389/1059) overall and 26.3% (94/358) among in-service professionals. The mean score gain in knowledge after access to the course of 606 participants who had pre-and post-assessment data was 11.8 (95% CI 10.8, 12.9 P<.001) – a relative increase of 41.5%. The proportion who achieved above the pass mark post-training was 58.7% (356/606), compared with 18.2% (110/606) pre-training. Of the in-service professionals, 86% (128/149) reported applying their knowledge by changing their clinical practice in screening, assessment, diagnosis and/or management. This group demonstrated significantly increased, retained knowledge 6-months after training (mean difference (SD) from pre-assessment:12.1 (11.8)), retaining 65.8% (12.1/18.4) of gained knowledge from the training. Changes in the management of malnutrition were reported by trained participants, and institutional operational and policy changes were also found. CONCLUSIONS The Malnutrition eLearning course improved knowledge, understanding and skills of health professionals in the diagnosis and management of children with severe acute malnutrition, and changes in clinical practice and confidence were reported following completion of the course.

We validate our previously developed (DOI: 10.1101/089227) clinical prediction rule for diagnosing transient ischemic attack on the basis of presenting clinical symptoms and compare its performance with the ABCD2 score in first-contact patient settings. Two independent and prospectively collected patient validation cohorts were used: (a) referral cohort–prospectively referred emergency department and general practitioner patients (N = 877); and (b) SpecTRA cohort–participants recruited as part of the SpecTRA biomarker project (N = 545). Outcome measure consisted of imaging-confirmed clinical diagnosis of mild stroke/transient ischemic attack. Results showed that our clinical prediction rule demonstrated significantly higher accuracy than the ABCD2 score for both the referral cohort (70.5% vs 59.0%; p < 0.001) and SpecTRA cohort (72.8% vs 68.3%; p = 0.028). We discuss the potential of our clinical prediction rule to replace the use of the ABCD2 score in the triage of transient ischemic attack clinic referrals.