Medical students' perceptions and expectations regarding digital health education and training: A qualitative study.

INTRODUCTION: Digital health - the convergence of digital technologies within health and health care to enhance the efficiency of health-care delivery - is fast becoming an integral part of routine medical practice. The integration of digital health into traditional practice brings significant changes. Logic dictates that for medical practitioners to operate in this new digitally enabled environment, they require specific knowledge, skills and competencies relating to digital health. However, very few medical programmes in Australia and globally include digital health within their regular curriculum. This pilot study aimed to explore medical students' perceptions and expectations of digital health education and training (ET). METHODS: An online survey and focus groups were used to collect information about medical students' perceptions and expectations relating to digital health and ET relating to this field within the medical programme at the University of Queensland. Sixty-three students took part in the survey, and 17 students were involved in four focus groups. RESULTS: Most participants had no formal ET in digital health. Most participants (n = 43; 68%) expressed a willingness to learn about digital health as part of their medical programme. DISCUSSION: Primarily, knowledge- and practice-related factors have motivated students to learn about digital health. The analysis of focus group data identified two superordinate themes: (a) drivers of digital health ET and (b) expectations relating to digital health ET. Students agreed that digital health is a relevant field for their future practice that should be taught as part of their regular curriculum.

Telemedicine: Niche or mainstream? A bibliometric analysis and review of the output of highly ranked clinical journals.

Historically, telemedicine research is predominantly published in discipline-specific telemedicine journals. However, in recent times the number of publications on telemedicine in clinical journals has increased. Acceptance of telemedicine research by clinical journals indicates a maturing of the telemedicine field. This bibliometric study reviewed telemedicine-related literature published in clinical journals from 2008 to 2018. A search was conducted in PubMed using two types of clinical outlets. (1) Top 20 journals with highest Impact Factor in the field of Medicine. (2) Top five journals with highest Impact Factor in most common Medical Specialty Areas. Analysis showed that there is a steady growth of literature relating to research and non-research publications appearing in clinical journals. Top five journals in the field of Medicine - BMJ, JAMA, Cochrane database, Medical Journal of Australia and Lancet have published 64% (n = 270) of telemedicine-related articles for the study period. Disease areas associated with telemedicine publications are consistent with global disease priorities. The review demonstrated that the most significant increase in telemedicine research published in clinical journals was focused on patient care.

Designing an Optimum Fiscal Policy for Tobacco to Maximise the Tax Revenue, Social Savings and the Net Monetary Benefits in Sri Lanka.

BACKGROUND: Fiscal policy targeting tobacco control is identified as the most effective strategy for rapid control of tobacco use. An optimum fiscal policy to estimate the percentage taxation that will maximise the government tax revenue, social savings and the net monetary benefit has not been empirically designed before in Sri Lanka. METHODS: A model was developed using Microsoft Excel 2016, utilizing up-to-date published evidence on the cigarette sales, current fiscal policy, social cost of tobacco use, consumer response and the price elasticity of cigarettes. Univariate estimates on the expected revenue from tobacco tax, average annual social savings and the net monetary benefit were predicted for different levels of tobacco taxation. A deterministic sensitivity analysis was performed covering all possibilities. The percentage taxation maximizing the government tax revenue and the net monetary benefit were identified. RESULTS: It was estimated that a further 30% tax increase from the 2019 baseline will generate approximately LKR 3544 million per year of additional tax revenue for the government while saving LKR 28 069 million per annum as social savings. A fiscal elevation of 50% will produce identical annual tax revenue to that of 2018, while securing a social saving of more than LKR 47 600 million per annum. The maximum net monetary benefit is achievable at an overnight tax increase of 90% from the baseline, however with a short-term compromise in tax revenue. CONCLUSION: The well-defined thresholds take tobacco taxation advocacy in Sri Lanka a step forward and will assist the government in taking an informed decision on its fiscal policy for cigarettes.

A Systematic Review of Pediatric Telediabetes Service Models.

Telediabetes may improve patient access to clinicians who specialize in the management of pediatric diabetes. Due to the diversity of telehealth modes, many different service models for pediatric telediabetes have been developed. This review describes pediatric telediabetes service models identified in the literature, investigates the reported changes in HbA1c of these interventions, and describes enablers and barriers to implementing a telediabetes service. Evaluation of current literature may inform the development and sustainability of telehealth services for pediatric diabetes management. Twenty-nine studies met inclusion criteria and were reviewed. This review has demonstrated that pediatric telediabetes can be delivered by remote monitoring and real-time videoconference modes. Overall, pediatric telediabetes increased interactions between patients and clinicians, improved access to specialized care, and facilitated increased diabetes monitoring. In some contexts, telediabetes also improved short-term glycemic control. Key enablers reported for telediabetes services were integration with existing workflows, dedicated staff, clinician and patient training, appropriate data security, technology with good usability, and the availability of technical support. Barriers included increases in patient responsibilities and clinician workload, and technical issues with equipment and software.

Stress and its Social Determinants - A Qualitative Study Reflecting the Perceptions of a Select Small Group of the Public in Sri Lanka.

BACKGROUND: Exposure to stress, especially for prolonged periods, can result in physical and mental disorders. To attribute causality to its associated disease profile, social determinants need to be identified at the population level. The objective of this study was to explore perceptions regarding stress and its probable social determinants, among a purposeful cohort of the public from Colombo district, Sri Lanka. METHODS: A qualitative study using focus group discussions (FGDs) was conducted among adults. Purposive sampling was used to recruit 8--10 participants into homogenous groups. Data were collected until information saturation. A semistructured FGD guide was used to facilitate the discussions. Content analysis methods were used to analyze data. RESULTS: Six FGDs consisting of 59 participants were conducted. Participants included primary healthcare workers, community members, village leaders, private and public sector employees, unemployed individuals, homemakers, self-employed persons, slum dwellers, and persons from affluent communities. Three main themes emerged: social, economic, and cultural factors. Social factors consisted of four sub-themes: social role or status, generation gap, disability, and unsafe environment. Economic factors included three related subthemes: poverty, unemployment, and job insecurity. Cultural factors included three subthemes: superstitious beliefs, religion and caste, marriage and dowry. CONCLUSION: Elements regarding stress and its social determinants among the public in Sri Lanka seem to be an amalgam of interconnected sociocultural and economic factors. However, addressing these social determinants in isolation (at an individual level) may not be feasible, as most causes appear to be outside the scope of the individual.

Effectiveness of text messaging interventions for the management of depression: A systematic review and meta-analysis.

INTRODUCTION: Depression is a leading cause of human disability. Telemedicine-based interventions using text messaging are currently being trialled for the management of community-based clients with clinical depression. However, little is known about the effectiveness of such methods. METHODS: We searched the databases PubMed, Embase, Informit, Cochrane Central Register of Controlled Trials, PsycINFO and Scopus for randomised controlled trials (RCTs) published between January 2000 and April 2019. Studies comparing text messaging interventions to a comparator group for patients with depression were included in the review. Articles were assessed for quality using the Joanna Briggs Institute critical appraisal checklist for RCTs. RESULTS: Nine RCTs (945 patients: 764 adults and 181 adolescents) were included in the systematic review. Five studies used text messaging as the only intervention, whilst the remaining combined text messaging with other treatment modalities such as behavioural activation or cognitive behavioural therapy. A meta-analysis was conducted on seven selected RCTs (845 patients: 664 adults and 181 adolescents). The standardised mean reduction in depression due to text messaging interventions was 0.23 (95% confidence interval: -0.02 to 0.48). There was evidence of heterogeneity in treatment effect between studies. DISCUSSION: There is marginal evidence supporting text messaging interventions as an effective treatment modality for people living with clinical depression. However, further research is needed to determine how best to utilise text-message interventions alongside other conventional forms of health services delivery.

How valid is Obsessive-Compulsive Inventory-Revised Scale Among Sri Lankan adults?

BACKGROUND: Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder with a lifetime prevalence of 1.9%-3.0% in the general population. It is an easily missed diagnosis. Although several paper-based tools have been developed, none are culturally validated for Sri Lankans to screen for OCD at field level. AIMS: This study aimed to translate and assess the validity and reliability of obsessive-compulsive inventory-revised scale (OCI-R) for Sri Lankan adults. SETTING AND DESIGN: This study was a case-control study. MATERIALS AND METHODS: This was conducted among 89 OCD patients and 89 controls recruited from the National Hospital of Sri Lanka to assess the criterion validity of OCI-R (an 18-item tool on common OCD symptoms using six subscales), by applying it and the gold standard (clinical diagnosis made by two independent consultant psychiatrists) to the same patient simultaneously. Before this, the tool was translated into local language (Sinhala) by bilingual experts and two psychiatrists using the forward-backward translation method. Receiver operating characteristics (ROC) curve was drawn to determine the cutoff value to identify OCD in Sri Lanka. RESULTS: The translated tool demonstrated the following: sensitivity 84.4%, specificity 85.6%, positive predictive value 85.4%, negative predictive value 84.6%, and positive and negative likelihood ratios of 5.86 and 0.18, respectively. The cutoff value for diagnosing OCD was 21 according to the ROC curve. Internal consistency (Cronbach's alpha reliability coefficient) of all six domains and the total scale showed values exceeding Nunnally's criteria of 0.7. CONCLUSIONS: Sinhala version of the OCI-R scale was identified as a valid and reliable screening instrument to be applied in Sri Lankan adults.

Telemedicine in the correctional setting: A scoping review.

Introduction The access healthcare services to inmates within correctional settings has generally been low and problematic due to specific nature of the prison setting. Telemedicine has been used as an alternative delivery mode. This study aimed to collate the current evidence related to the use of telemedicine to deliver health services within correctional settings. Methods A comprehensive search of seven databases - PubMed, Embase, CINAHL, Informit, Cochrane Central Register of Controlled Trials, PsycINFO and Scopus, for peer-reviewed publications was conducted in April, 2018. Results Initial search identified 1147 articles. After review of the title and abstract, 36 articles were included in the final review. Of the included articles, 19 (53%) were published during the period of 2010-2018. Articles were predominantly from the USA ( n = 23; 64 %), France and Australia. There were 23 descriptive studies (64%), five costing studies (14%) five experimental studies (14%), two mixed methods (6%) and one qualitative study (3%). The experimental studies were predominantly focused on mental health services ( n = 4, 80%). The commonest telemedicine intervention used was synchronous videoconferencing ( n = 21, 58%), while eight articles (22%) described asynchronous interventions. Telemedicine interventions were mainly used for mental health ( n = 13), and ophthalmology ( n = 4) disciplines. Discussion In the right circumstances, telemedicine interventions within correctional settings seem to be a useful method in connecting inmates with essential health services.