{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T11:54:49Z","timestamp":1765886089172,"version":"3.37.3"},"reference-count":24,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Non-invasive respiratory support using bubble continuous positive airway pressure (bCPAP) is useful in treating babies with respiratory distress syndrome. Despite its proven clinical and cost-effectiveness, implementation is hampered by the inappropriate administration of bCPAP in low-resource settings. A clinical algorithm\u2014\u2018TRY\u2019 (based on Tone: good; Respiratory distress; Yes, heart rate above 100 beats\/min)\u2014has been developed to correctly identify which newborns would benefit most from bCPAP in a teaching hospital in Malawi.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the reliability, sensitivity and specificity of TRY when employed by nurses in a Malawian district hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Nursing staff in a Malawian district hospital baby unit were asked, over a 2-month period, to complete TRY assessments for every newly admitted baby with the following inclusion criteria: clinical evidence of respiratory distress and\/or birth weight less than 1.3\u2009kg. A visiting paediatrician, blinded to nurses\u2019 assessments, concurrently assessed each baby, providing both a TRY assessment and a clinical decision regarding the need for CPAP administration. Inter-rater reliability was calculated comparing nursing and paediatrician TRY assessment outcomes. Sensitivity and specificity were estimated comparing nurse TRY assessments against the paediatrician\u2019s clinical decision.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two hundred and eighty-seven infants were admitted during the study period; 145 (51%) of these met the inclusion criteria, and of these 57 (39%) received joint assessments. The inter-rater reliability was high (kappa 0.822). Sensitivity and specificity were 92% and 96%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>District hospital nurses, using the TRY-CPAP algorithm, reliably identified babies that might benefit from bCPAP and thus improved its effective implementation.<\/jats:p><\/jats:sec>","DOI":"10.1136\/archdischild-2017-313867","type":"journal-article","created":{"date-parts":[[2018,3,7]],"date-time":"2018-03-07T17:42:11Z","timestamp":1520444531000},"page":"732-738","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Evaluation of \u2018TRY\u2019: an algorithm for neonatal continuous positive airways pressure in low-income settings"],"prefix":"10.1136","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3655-6954","authenticated-orcid":false,"given":"Caroline","family":"Crehan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Colbourn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Heys","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Molyneux","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,3,7]]},"reference":[{"key":"2020050712445618000_103.8.732.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61698-6"},{"key":"2020050712445618000_103.8.732.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60496-7"},{"key":"2020050712445618000_103.8.732.3","first-page":"CD002271","article-title":"Continuous distending pressure for respiratory distress syndrome in preterm infants","volume":"7","author":"Ho","year":"2000","journal-title":"Cochrane Database Syst Rev"},{"key":"2020050712445618000_103.8.732.4","unstructured":"Hadley Health Technologies. Pumani bCPAP user manual and repair manual [Internet]. [cited 2017 Nov 15]. p. 5 (Appendix A). https:\/\/www.viaglobalhealth.com\/wp-content\/uploads\/2016\/01\/3-378-Pumani-CPAP-User-Manual-H.pdf"},{"key":"2020050712445618000_103.8.732.5","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-014-0288-1"},{"key":"2020050712445618000_103.8.732.6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0053622"},{"key":"2020050712445618000_103.8.732.7","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-10-30"},{"key":"2020050712445618000_103.8.732.8","doi-asserted-by":"publisher","DOI":"10.1093\/tropej\/49.3.148"},{"key":"2020050712445618000_103.8.732.9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0086327"},{"key":"2020050712445618000_103.8.732.10","doi-asserted-by":"publisher","DOI":"10.1179\/1465328110Y.0000000001"},{"key":"2020050712445618000_103.8.732.11","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2014-308082"},{"key":"2020050712445618000_103.8.732.12","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.03438"},{"key":"2020050712445618000_103.8.732.13","doi-asserted-by":"crossref","first-page":"342","DOI":"10.14238\/pi48.6.2008.342-5","article-title":"Downes score as a clinical assessment for hypoxemia in neonates with respiratory distress","volume":"48","author":"Rusmawati","year":"2008","journal-title":"Paediatr Indones"},{"key":"2020050712445618000_103.8.732.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2008.10.049"},{"key":"2020050712445618000_103.8.732.15","doi-asserted-by":"publisher","DOI":"10.1179\/2046905513Y.0000000053"},{"key":"2020050712445618000_103.8.732.16","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2013-305877"},{"key":"2020050712445618000_103.8.732.17","unstructured":"COIN Course T. 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Integrated management of childhood illness, maternal, newborn, child and adolescent health. 2016 http:\/\/www.who.int\/maternal_child_adolescent\/topics\/child\/nutrition\/breastfeeding\/en\/"},{"key":"2020050712445618000_103.8.732.20","doi-asserted-by":"crossref","first-page":"e201","DOI":"10.1016\/S2214-109X(15)00294-6","article-title":"Malawi and Millennium development goal 4: a countdown to 2015 country case study","volume":"4","author":"Kanyuka","year":"2016","journal-title":"Lancet Glob Health"},{"key":"2020050712445618000_103.8.732.21","first-page":"1","article-title":"Integrated management of childhood illness (IMCI) strategy for children under five","volume":"6","author":"Gera","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"2020050712445618000_103.8.732.22","unstructured":"Malawi Ministry of Health. Malawi every newborn action plan [Internet]. 2015 www.who.int\/pmnch\/media\/events\/2015\/malawi_enap.pdf"},{"key":"2020050712445618000_103.8.732.23","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1179\/2046905515Y.0000000034","article-title":"New technologies for essential newborn care in under-resourced areas: what is needed and how to deliver it","volume":"35","author":"Maynard","year":"2015","journal-title":"Paediatr Int Child Health"},{"key":"2020050712445618000_103.8.732.24","unstructured":"3rd Stone Design. 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