PDF(Pubmed)
Abstract：
UNASSIGNED: With a neonatal mortality rate of 33 per 1,000 live births in 2019, Ethiopia is striving to attain the Sustainable Development Goal target of 12 deaths per 1,000 live births by 2030. A better understanding of the major causes of neonatal mortality is needed to effectively design and implement interventions to achieve this goal. Minimally Invasive Tissue Sampling (MITS), an alternative to conventional autopsy, requires fewer resources and through task-shifting of sample collection from pathologists to nurses, has the potential to support the expansion of pathology-based post-mortem examination and improve mortality data. This paper evaluates the accuracy and adequacy of MITS performed by nurses at a tertiary and general hospital and in the home of the deceased.
UNASSIGNED: Nurses in a tertiary and general hospital in Ethiopia were trained in MITS sample collection on neonatal deaths and stillbirths using standardized protocols. MITS sample collection was performed by both pathologists and nurses in the tertiary hospital and by nurses in the general hospital and home-setting. Agreement in the performance of MITS between pathologists and nurses was calculated for samples collected at the tertiary hospital. Samples collected by nurses in the general hospital and home-setting were evaluated for technical adequacy using preestablished criteria.
UNASSIGNED: One hundred thirty-nine MITS were done: 125 in hospitals and 14 inside homes. There was a perfect or almost perfect agreement between the pathologists and the nurses in the tertiary hospital using Gwet\'s agreement interpretation criteria. The adequacy of MITS samples collected by nurses in the general hospital was more than 72% when compared to the preset criteria. The adequacy of the MITS sampling yield ranged from 87% to 91% on liveborn neonatal deaths and 76% for the liver, right and left lungs and 55% for brain tissues in stillbirths.
UNASSIGNED: This study demonstrated that task-shifting MITS sample collection to nurses can be achieved with comparable accuracy and adequacy as pathologists. Our study showed that with standardized training and supportive supervision MITS sample collection can be conducted by nurses in a tertiary, general hospital and, at the home of the deceased. Future studies should validate and expand on this work by evaluating task-shifting of MITS sample collection to nurses within community settings and with larger sample sizes.
UNASSIGNED: Nurses in a tertiary and general hospital in Ethiopia were trained in MITS sample collection on neonatal deaths and stillbirths using standardized protocols. MITS sample collection was performed by both pathologists and nurses in the tertiary hospital and by nurses in the general hospital and home-setting. Agreement in the performance of MITS between pathologists and nurses was calculated for samples collected at the tertiary hospital. Samples collected by nurses in the general hospital and home-setting were evaluated for technical adequacy using preestablished criteria.
UNASSIGNED: One hundred thirty-nine MITS were done: 125 in hospitals and 14 inside homes. There was a perfect or almost perfect agreement between the pathologists and the nurses in the tertiary hospital using Gwet\'s agreement interpretation criteria. The adequacy of MITS samples collected by nurses in the general hospital was more than 72% when compared to the preset criteria. The adequacy of the MITS sampling yield ranged from 87% to 91% on liveborn neonatal deaths and 76% for the liver, right and left lungs and 55% for brain tissues in stillbirths.
UNASSIGNED: This study demonstrated that task-shifting MITS sample collection to nurses can be achieved with comparable accuracy and adequacy as pathologists. Our study showed that with standardized training and supportive supervision MITS sample collection can be conducted by nurses in a tertiary, general hospital and, at the home of the deceased. Future studies should validate and expand on this work by evaluating task-shifting of MITS sample collection to nurses within community settings and with larger sample sizes.
摘要：
由于2019年新生儿死亡率为每千名活产33例，埃塞俄比亚正在努力实现可持续发展目标，即到2030年每千名活产12例死亡。需要更好地了解新生儿死亡的主要原因，以有效地设计和实施干预措施来实现这一目标。微创组织取样(MITS),传统尸检的替代方法,需要更少的资源，并且通过将样本收集的任务从病理学家转移到护士，有可能支持基于病理学的验尸检查的扩展并改善死亡率数据。本文评估了三级医院和综合医院以及死者家中的护士进行MITS的准确性和充分性。
■埃塞俄比亚一家三级医院和综合医院的护士接受了关于新生儿死亡和死产的MITS样本收集的标准化方案培训。MITS样本收集由三级医院的病理学家和护士以及综合医院和家庭环境的护士进行。对于在三级医院收集的样本，计算了病理学家和护士之间MITS性能的一致性。使用预先制定的标准评估了综合医院和家庭环境中护士收集的样品的技术充分性。
■完成了一百三十九个MITS：125个在医院，14个在家里。使用Gwet的协议解释标准，三级医院的病理学家和护士之间存在完美或几乎完美的协议。与预设标准相比，综合医院护士收集的MITS样本的充分性超过72％。MITS采样产量的充分性在活出生新生儿死亡的87％至91％之间，在肝脏的76％之间，右肺和左肺和55％的脑组织在死胎。
■这项研究表明，与病理学家一样，可以实现将MITS样本收集任务转移给护士的准确性和充分性。我们的研究表明，通过标准化培训和支持性监督，可以由三级护士进行MITS样本收集，综合医院,在死者的家中。未来的研究应该通过评估MITS样本收集的任务转移到社区环境中的护士和更大的样本量来验证和扩展这项工作。
■埃塞俄比亚一家三级医院和综合医院的护士接受了关于新生儿死亡和死产的MITS样本收集的标准化方案培训。MITS样本收集由三级医院的病理学家和护士以及综合医院和家庭环境的护士进行。对于在三级医院收集的样本，计算了病理学家和护士之间MITS性能的一致性。使用预先制定的标准评估了综合医院和家庭环境中护士收集的样品的技术充分性。
■完成了一百三十九个MITS：125个在医院，14个在家里。使用Gwet的协议解释标准，三级医院的病理学家和护士之间存在完美或几乎完美的协议。与预设标准相比，综合医院护士收集的MITS样本的充分性超过72％。MITS采样产量的充分性在活出生新生儿死亡的87％至91％之间，在肝脏的76％之间，右肺和左肺和55％的脑组织在死胎。
■这项研究表明，与病理学家一样，可以实现将MITS样本收集任务转移给护士的准确性和充分性。我们的研究表明，通过标准化培训和支持性监督，可以由三级护士进行MITS样本收集，综合医院,在死者的家中。未来的研究应该通过评估MITS样本收集的任务转移到社区环境中的护士和更大的样本量来验证和扩展这项工作。
