Abrupt change to telephone follow-up clinics in a regional rheumatology service during COVID-19: analysis of treatment decisions.

During the 2020 COVID-19 lockdown our rheumatology service provided follow up by phone. We reviewed clinic documents to compare patients serviced, and patient assessment and treatment outcomes. More patients received care during the lockdown but patient rheumatic disease was deemed active less frequently, more patients had no change to disease-modifying anti-rheumatic drugs and patients were less likely to have an intervention arranged. This suggests careful patient selection and appropriate infrastructure should be part of future rheumatology telemedicine.

Measuring the Quality of Clinical Skills Mobile Apps for Student Learning: Systematic Search, Analysis, and Comparison of Two Measurement Scales.

BACKGROUND: Mobile apps are widely used in health professions, which increases the need for simple methods to determine the quality of apps. In particular, teachers need the ability to curate high-quality mobile apps for student learning. OBJECTIVE: This study aims to systematically search for and evaluate the quality of clinical skills mobile apps as learning tools. The quality of apps meeting the specified criteria was evaluated using two measures-the widely used Mobile App Rating Scale (MARS), which measures general app quality, and the Mobile App Rubric for Learning (MARuL), a recently developed instrument that measures the value of apps for student learning-to assess whether MARuL is more effective than MARS in identifying high-quality apps for learning. METHODS: Two mobile app stores were systematically searched using clinical skills terms commonly found in medical education and apps meeting the criteria identified using an approach based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 9 apps were identified during the screening process. The apps were rated independently by 2 reviewers using MARS and MARuL. RESULTS: The intraclass correlation coefficients (ICCs) for the 2 raters using MARS and MARuL were the same (MARS ICC [two-way]=0.68; P<.001 and MARuL ICC [two-way]=0.68; P<.001). Of the 9 apps, Geeky Medics-OSCE revision (MARS Android=3.74; MARS iOS=3.68; MARuL Android=75; and MARuL iOS=73) and OSCE PASS: Medical Revision (MARS Android=3.79; MARS iOS=3.71; MARuL Android=69; and MARuL iOS=73) scored highly on both measures of app quality and for both Android and iOS. Both measures also showed agreement for the lowest rated app, Patient Education Institute (MARS Android=2.21; MARS iOS=2.11; MARuL Android=18; and MARuL iOS=21.5), which had the lowest scores in all categories except information (MARS) and professional (MARuL) in both operating systems. MARS and MARuL were both able to differentiate between the highest and lowest quality apps; however, MARuL was better able to differentiate apps based on teaching and learning quality. CONCLUSIONS: This systematic search and rating of clinical skills apps for learning found that the quality of apps was highly variable. However, 2 apps-Geeky Medics-OSCE revision and OSCE PASS: Medical Revision-rated highly for both versions and with both quality measures. MARS and MARuL showed similar abilities to differentiate the quality of the 9 apps. However, MARuL's incorporation of teaching and learning elements as part of a multidimensional measure of quality may make it more appropriate for use with apps focused on teaching and learning, whereas MARS's more general rating of quality may be more appropriate for health apps targeting a general health audience. Ratings of the 9 apps by both measures also highlighted the variable quality of clinical skills mobile apps for learning.

A Tool for Rating the Value of Health Education Mobile Apps to Enhance Student Learning (MARuL): Development and Usability Study.

BACKGROUND: To realize the potential for mobile learning in clinical skills acquisition, medical students and their teachers should be able to evaluate the value of an app to support student learning of clinical skills. To our knowledge, there is currently no rubric for evaluation of quality or value that is specific for apps to support medical student learning. Such a rubric might assist students to be more confident in using apps to support their learning. OBJECTIVE: The objective of this study was to develop an instrument that can be used by health professional educators to rate the value of a mobile app to support health professional student learning. METHODS: Using the literature, we developed a list of potential criteria for the evaluation of educational app value, which were then refined with a student group using a modified nominal group technique. The refined list was organized into themes, and the initial rubric, Mobile App Rubric for Learning (MARuL, version 1), was developed. iOS and Android app stores were searched for clinical skills apps that met our inclusion criteria. After the 2 reviewers were trained and the item descriptions were refined (version 2), a random sample of 10 included apps, 5 for each mobile operating system, was reviewed. Interitem and interrater analyses and discussions with the reviewers resulted in refinement of MARuL to version 3. The reviewers completed a review of 41 clinical skills mobile apps, and a second round of interitem and interrater reliability testing was performed, leading to version 4 of the MARuL. RESULTS: Students identified 28 items (from an initial set of 144 possible items) during the nominal group phase, and these were then grouped into 4 themes: teaching and learning, user centered, professional, and usability. Testing and refinement with reviewers reduced the list to 26 items. Internal consistency for MARuL was excellent (α=.96), and the interrater reliability as measured by the intraclass correlation coefficient (ICC) was good (ICC=0.66). CONCLUSIONS: MARuL offers a fast and user-friendly method for teachers to select valuable apps to enhance student learning.

The incidence and risk factors of dog bite injuries requiring hospitalisation in New Zealand.

AIM: This retrospective cohort study aims to describe the incidence of dog bite injuries requiring hospitalisation across New Zealand in the 10-year period between 2004 and 2014. METHOD: The National Minimum Dataset (NMDS) was used to collate information from public and private hospital discharges for publicly funded events in New Zealand with the external cause of injury code W54.0 (Bitten by Dog) during the period of 1 July 2004 to 30 June 2014. Information regarding potential risk factors and indicators of severity was also collected. RESULTS: From 2004 to 2014 there were 4,958 dog bites requiring hospitalisation in New Zealand, giving an overall incidence of 11.3 (11.0-11.6) per 100,000 people per annum, representing 496 events per year on average. The average length of stay in hospital was 2.5 days (SD = 3.5 days). The overall incidence has been rising during this period from 9.7 (8.8-10.7) per 100,000 population per annum in 2004 to a peak of 12.3 (11.3-13.4) per 100,000 in 2013/14. The highest risk factors were identified as children under the age of 10 years, Maori and those with a higher deprivation score. In cases where the scene of injury was recorded, 69% occurred at a private residence or property. Head and neck bites were increasingly common in younger age groups, with 78% of the 0-4 year age group and 63% of the 5-9 year age group injured in the head/neck region. Upper and lower limb bites were increasingly common in older age groups. CONCLUSIONS: The incidence of dog bite injuries requiring hospitalisation has continued to rise in comparison with previously published rates in New Zealand. Additionally, more vulnerable population subgroups have been identified who are most likely to require hospitalisation.

Mapping GABA and glutamate inputs to gonadotrophin-releasing hormone neurones in male and female mice.

Gonadotrophin-releasing hormone (GnRH) neurone function is dependent upon gonadal steroid hormone feedback, which is communicated in large part through an afferent neuronal network. The classical neurotransmitters GABA and glutamate are important regulators of GnRH neurone activity and are implicated in mediating feedback signals. In the present study, we aimed to determine whether GABAergic or glutamatergic input to GnRH neurones differs between males and females and/or exhibits morphological plasticity in response to steroid hormone feedback in females. Tissue collected from GnRH-green fluorescent protein (GFP) male and female mice in dioestrus underwent immunofluorescence labelling of GFP and either the vesicular GABA transporter (VGAT) or the vesicular glutamate transporter 2 (VGLUT2). No differences in the densities or absolute numbers of VGAT-immunoreactive (-IR) or VGLUT2-IR puncta apposed to GnRH neurones were identified between males and females. The most significant input from either neurotransmitter was to the proximal dendritic region and 80% of VGAT-IR puncta apposed to GnRH neurones co-localised with synaptophysin. Putative inputs were also assessed in ovariectomised (OVX) female mice treated with negative (OVX+E) or positive (OVX+E+E) feedback levels of oestrogen, and OVX+E+E mice were killed during the expected GnRH/luteinising hormone surge. No differences in VGLUT2-IR contacts to GnRH neurones were identified between animals under the negative-feedback influence of oestrogen (OVX+E) or the positive influence of oestrogen (OVX+E+E), regardless of cFos activation status. By contrast, a significant elevation in putative GABAergic inputs to GnRH neurones at the time of the preovulatory surge was found in the cFos-negative subset of GnRH neurones, both at the level of the soma and at the proximal dendrite. Taken together, these data suggest that, although GABAergic and glutamatergic innervation of GnRH neurones is not sexually differentiated, cyclic fluctuations in steroid hormone feedback over the female oestrous cycle result in plastic changes in GABAergic inputs to a subpopulation of GnRH neurones.

Reliability and refinement of a pain location tool for children's abdominal surgery.

AIM: To determine the 'inter-rater' and test-retest reliability of a pain location tool for children. MATERIALS & METHODS: In children aged 5-14 years who had undergone a laparoscopic operation, pain scores at each of seven abdominal locations, and at the shoulder tip, were recorded at baseline and after a 5- and 30-min interval. RESULTS: Intraclass correlation coefficients were predominantly in the 'moderate' to 'substantial' range for both 'inter-rater' and test-retest reliability. Three quarters of children would prefer an electronic version of the tool. Thematic analysis showed accuracy, usability, utility and usefulness were areas for future development. CONCLUSION: Children can reliably indicate where they hurt after laparoscopic surgery. An electronic version could increase acceptability to children and usability by professionals.