Capacity-Building and Clinical Competence in Infectious Disease in Uganda: A Mixed-Design Study with Pre/Post and Cluster-Randomized Trial Components
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{"title"=>"Capacity-Building and Clinical Competence in Infectious Disease in Uganda: A Mixed-Design Study with Pre/Post and Cluster-Randomized Trial Components", "type"=>"journal", "authors"=>[{"first_name"=>"Marcia R.", "last_name"=>"Weaver", "scopus_author_id"=>"7201548872"}, {"first_name"=>"Ian", "last_name"=>"Crozier", "scopus_author_id"=>"57196632547"}, {"first_name"=>"Simon", "last_name"=>"Eleku", "scopus_author_id"=>"55532319000"}, {"first_name"=>"Gyaviira", "last_name"=>"Makanga", "scopus_author_id"=>"55532704400"}, {"first_name"=>"Lydia", "last_name"=>"Mpanga Sebuyira", "scopus_author_id"=>"6504363796"}, {"first_name"=>"Janepher", "last_name"=>"Nyakake", "scopus_author_id"=>"55532268300"}, {"first_name"=>"Mary Lou", "last_name"=>"Thompson", "scopus_author_id"=>"7404620948"}, {"first_name"=>"Kelly", "last_name"=>"Willis", "scopus_author_id"=>"54969750500"}], "year"=>2012, "source"=>"PLoS ONE", "identifiers"=>{"sgr"=>"84871305048", "doi"=>"10.1371/journal.pone.0051319", "pui"=>"366296349", "pmid"=>"23272097", "scopus"=>"2-s2.0-84871305048", "issn"=>"19326203", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)"}, "id"=>"0438d820-ac01-3fa7-912a-d349bdc7a72e", "abstract"=>"TRIAL DESIGN: Best practices for training mid-level practitioners (MLPs) to improve global health-services are not well-characterized. Two hypotheses were: 1) Integrated Management of Infectious Disease (IMID) training would improve clinical competence as tested with a single arm, pre-post design, and 2) on-site support (OSS) would yield additional improvements as tested with a cluster-randomized trial.\\n\\nMETHODS: Thirty-six Ugandan health facilities (randomized 1∶1 to parallel OSS and control arms) enrolled two MLPs each. All MLPs participated in IMID (3-week core course, two 1-week boost sessions, distance learning). After the 3-week course, OSS-arm trainees participated in monthly OSS. Twelve written case scenarios tested clinical competencies in HIV/AIDS, tuberculosis, malaria, and other infectious diseases. Each participant completed different randomly-assigned blocks of four scenarios before IMID (t0), after 3-week course (t1), and after second boost course (t2, 24 weeks after t1). Scoring guides were harmonized with IMID content and Ugandan national policy. Score analyses used a linear mixed-effects model. The primary outcome measure was longitudinal change in scenario scores.\\n\\nRESULTS: Scores were available for 856 scenarios. Mean correct scores at t0, t1, and t2 were 39.3%, 49.1%, and 49.6%, respectively. Mean score increases (95% CI, p-value) for t0-t1 (pre-post period) and t1-t2 (parallel-arm period) were 12.1 ((9.6, 14.6), p<0.001) and -0.6 ((-3.1, +1.9), p = 0.647) percent for OSS arm and 7.5 ((5.0, 10.0), p<0.001) and 1.6 ((-1.0, +4.1), p = 0.225) for control arm. The estimated mean difference in t1 to t2 score change, comparing arm A (participated in OSS) vs. arm B was -2.2 ((-5.8, +1.4), p = 0.237). From t0-t2, mean scores increased for all 12 scenarios.\\n\\nCONCLUSIONS: Clinical competence increased significantly after a 3-week core course; improvement persisted for 24 weeks. No additional impact of OSS was observed. Data on clinical practice, facility-level performance and health outcomes will complete assessment of overall impact of IMID and OSS.\\n\\nTRIAL REGISTRATION: ClinicalTrials.gov NCT01190540.", "link"=>"http://www.mendeley.com/research/capacitybuilding-clinical-competence-infectious-disease-uganda-mixeddesign-study-prepost-clusterrand", "reader_count"=>65, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>1, "Librarian"=>2, "Student > Doctoral Student"=>5, "Researcher"=>17, "Student > Ph. D. Student"=>9, "Student > Postgraduate"=>1, "Student > Master"=>11, "Other"=>6, "Student > Bachelor"=>5, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>1, "Professor"=>4}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>1, "Librarian"=>2, "Student > Doctoral Student"=>5, "Researcher"=>17, "Student > Ph. D. Student"=>9, "Student > Postgraduate"=>1, "Student > Master"=>11, "Other"=>6, "Student > Bachelor"=>5, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>1, "Professor"=>4}, "reader_count_by_subject_area"=>{"Unspecified"=>5, "Nursing and Health Professions"=>5, "Medicine and Dentistry"=>30, "Agricultural and Biological Sciences"=>5, "Arts and Humanities"=>2, "Neuroscience"=>1, "Business, Management and Accounting"=>4, "Social Sciences"=>10, "Decision Sciences"=>1, "Economics, Econometrics and Finance"=>2}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>30}, "Neuroscience"=>{"Neuroscience"=>1}, "Social Sciences"=>{"Social Sciences"=>10}, "Decision Sciences"=>{"Decision Sciences"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>5}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>5}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>4}, "Unspecified"=>{"Unspecified"=>5}, "Arts and Humanities"=>{"Arts and Humanities"=>2}}, "reader_count_by_country"=>{"United States"=>1, "Brazil"=>1, "United Kingdom"=>1}, "group_count"=>6}

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/524155"], "description"=>"<p>The figure shows the selection and random allocation of health facilities to two arms. Participants in arm A attended the Integrated Management of Infectious Disease (IMID) training program and On-Site Support. Participants in arm B attended IMID.</p>", "links"=>[], "tags"=>["diagram", "mid-level", "practitioners", "attended", "infectious", "diseases"], "article_id"=>194641, "categories"=>["Biotechnology", "Science Policy", "Medicine", "Infectious Diseases"], "users"=>["Marcia R. Weaver", "Ian Crozier", "Simon Eleku", "Gyaviira Makanga", "Lydia Mpanga Sebuyira", "Janepher Nyakake", "MaryLou Thompson", "Kelly Willis"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0051319.g002", "stats"=>{"downloads"=>3, "page_views"=>18, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Flow_diagram_of_mid_level_practitioners_who_attended_the_Integrated_Management_of_Infectious_Diseases_course_/194641", "title"=>"Flow diagram of mid-level practitioners who attended the Integrated Management of Infectious Diseases course.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-12-14 01:17:21"}
  • {"files"=>["https://ndownloader.figshare.com/files/524452"], "description"=>"<p>Abbreviations. t0: Pretest (baseline); t1: End of 3-week core course; t2: End of 2<sup>nd</sup> boost course (24 weeks after t1).</p>", "links"=>[], "tags"=>["scores", "changes"], "article_id"=>194946, "categories"=>["Biotechnology", "Science Policy", "Medicine", "Infectious Diseases"], "users"=>["Marcia R. Weaver", "Ian Crozier", "Simon Eleku", "Gyaviira Makanga", "Lydia Mpanga Sebuyira", "Janepher Nyakake", "MaryLou Thompson", "Kelly Willis"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0051319.t002", "stats"=>{"downloads"=>1, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Aggregate_Mean_New_Scenario_Scores_and_Score_Changes_by_Arm_and_Time_/194946", "title"=>"Aggregate Mean New Scenario Scores and Score Changes by Arm and Time.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-12-14 01:22:26"}
  • {"files"=>["https://ndownloader.figshare.com/files/283037", "https://ndownloader.figshare.com/files/283230", "https://ndownloader.figshare.com/files/283411"], "description"=>"<div><h3>Trial Design</h3><p>Best practices for training mid-level practitioners (MLPs) to improve global health-services are not well-characterized. Two hypotheses were: 1) Integrated Management of Infectious Disease (IMID) training would improve clinical competence as tested with a single arm, pre-post design, and 2) on-site support (OSS) would yield additional improvements as tested with a cluster-randomized trial.</p> <h3>Methods</h3><p>Thirty-six Ugandan health facilities (randomized 1∶1 to parallel OSS and control arms) enrolled two MLPs each. All MLPs participated in IMID (3-week core course, two 1-week boost sessions, distance learning). After the 3-week course, OSS-arm trainees participated in monthly OSS. Twelve written case scenarios tested clinical competencies in HIV/AIDS, tuberculosis, malaria, and other infectious diseases. Each participant completed different randomly-assigned blocks of four scenarios before IMID (t0), after 3-week course (t1), and after second boost course (t2, 24 weeks after t1). Scoring guides were harmonized with IMID content and Ugandan national policy. Score analyses used a linear mixed-effects model. The primary outcome measure was longitudinal change in scenario scores.</p> <h3>Results</h3><p>Scores were available for 856 scenarios. Mean correct scores at t0, t1, and t2 were 39.3%, 49.1%, and 49.6%, respectively. Mean score increases (95% CI, p-value) for t0–t1 (pre-post period) and t1–t2 (parallel-arm period) were 12.1 ((9.6, 14.6), p<0.001) and −0.6 ((−3.1, +1.9), p = 0.647) percent for OSS arm and 7.5 ((5.0, 10.0), p<0.001) and 1.6 ((−1.0, +4.1), p = 0.225) for control arm. The estimated mean difference in t1 to t2 score change, comparing arm A (participated in OSS) vs. arm B was −2.2 ((−5.8, +1.4), p = 0.237). From t0–t2, mean scores increased for all 12 scenarios.</p> <h3>Conclusions</h3><p>Clinical competence increased significantly after a 3-week core course; improvement persisted for 24 weeks. No additional impact of OSS was observed. Data on clinical practice, facility-level performance and health outcomes will complete assessment of overall impact of IMID and OSS.</p> <h3>Trial Registration</h3><p>ClinicalTrials.gov <a href=\"http://www.clinicaltrials.gov/ct2/show/NCT01190540\">NCT01190540</a></p> </div>", "links"=>[], "tags"=>["capacity-building", "competence", "infectious", "mixed-design", "cluster-randomized", "components"], "article_id"=>115811, "categories"=>["Cancer", "Science Policy", "Medicine", "Biotechnology"], "users"=>["Marcia R. Weaver", "Ian Crozier", "Simon Eleku", "Gyaviira Makanga", "Lydia Mpanga Sebuyira", "Janepher Nyakake", "MaryLou Thompson", "Kelly Willis"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0051319.s001", "https://dx.doi.org/10.1371/journal.pone.0051319.s002", "https://dx.doi.org/10.1371/journal.pone.0051319.s003"], "stats"=>{"downloads"=>18, "page_views"=>15, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Capacity_Building_and_Clinical_Competence_in_Infectious_Disease_in_Uganda_A_Mixed_Design_Study_with_Pre_Post_and_Cluster_Randomized_Trial_Components__/115811", "title"=>"Capacity-Building and Clinical Competence in Infectious Disease in Uganda: A Mixed-Design Study with Pre/Post and Cluster-Randomized Trial Components", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2012-12-14 01:36:51"}
  • {"files"=>["https://ndownloader.figshare.com/files/524009"], "description"=>"<p>Inclusion and exclusion criteria for health facilities and mid-level practitioners.</p>", "links"=>[], "tags"=>["exclusion", "facilities", "mid-level"], "article_id"=>194501, "categories"=>["Biotechnology", "Science Policy", "Medicine", "Infectious Diseases"], "users"=>["Marcia R. Weaver", "Ian Crozier", "Simon Eleku", "Gyaviira Makanga", "Lydia Mpanga Sebuyira", "Janepher Nyakake", "MaryLou Thompson", "Kelly Willis"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0051319.g001", "stats"=>{"downloads"=>1, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Inclusion_and_exclusion_criteria_for_health_facilities_and_mid_level_practitioners_/194501", "title"=>"Inclusion and exclusion criteria for health facilities and mid-level practitioners.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-12-14 01:15:01"}
  • {"files"=>["https://ndownloader.figshare.com/files/524331"], "description"=>"<p>The 72 IDCAP participants (36 from arm A, 36 from arm B) were randomly assigned to three groups, which contained 12 participants from each arm. The 12 clinical case scenarios were distributed across three, 4-scenario blocks (A, B, and C), and each group was assigned to a different sequence of blocks.</p>", "links"=>[], "tags"=>["scenarios"], "article_id"=>194824, "categories"=>["Biotechnology", "Science Policy", "Medicine", "Infectious Diseases"], "users"=>["Marcia R. Weaver", "Ian Crozier", "Simon Eleku", "Gyaviira Makanga", "Lydia Mpanga Sebuyira", "Janepher Nyakake", "MaryLou Thompson", "Kelly Willis"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0051319.g003", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Allocation_of_case_scenarios_across_testing_points_/194824", "title"=>"Allocation of case scenarios across testing points.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-12-14 01:20:24"}
  • {"files"=>["https://ndownloader.figshare.com/files/524414"], "description"=>"<p>Abbreviations. AIDS: acquired immune deficiency syndrome; ART: antiretroviral therapy; HIV: human immunodeficiency virus; IRIS: immune reconstitution inflammatory syndrome; PMCT: prevention of mother to child transmission (of HIV); TB: tuberculosis.</p>*<p>Although they did not focus on pregnancy, these scenarios also addressed antenatal and post-partum PMTCT protocols.</p>", "links"=>[], "tags"=>["scores", "scenarios"], "article_id"=>194908, "categories"=>["Biotechnology", "Science Policy", "Medicine", "Infectious Diseases"], "users"=>["Marcia R. Weaver", "Ian Crozier", "Simon Eleku", "Gyaviira Makanga", "Lydia Mpanga Sebuyira", "Janepher Nyakake", "MaryLou Thompson", "Kelly Willis"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0051319.t001", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Scenario_Content_Description_Evolution_of_Scores_on_New_Scenarios_by_Scenario_and_Block_/194908", "title"=>"Scenario Content Description; Evolution of Scores on New Scenarios by Scenario and Block.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-12-14 01:21:48"}

PMC Usage Stats | Further Information

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Relative Metric

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