Contrast-induced encephalopathy: a complication of coronary angiography.

Contrast-induced encephalopathy is a rare idiosyncratic reaction to contrast material. A 56-year-old woman with hypertension developed a hemiparesis with confusion and disorientation 3 hours after routine coronary angiography. The procedure had been prolonged, and during it she had received 130 mL of iopromide contrast. A metabolic screen was negative, and cerebral angiography and MR scan of brain were normal. She recovered completely by day 5. Contrast-induced encephalopathy should be considered in patients developing focal neurological deficits following coronary angiography. Patients requiring investigations to exclude acute stroke in this setting should not receive additional intravenous or intra-arterial contrast, although MR with gadolinium appears safe. Better awareness of this complication should avoid potentially harmful interventions such as thrombolysis.

Inflammation in ST- elevation myocardial infarction: risk factors, patterns of presentation and association with clinical picture and outcome, an observational study conducted at the Institute of Cardiology-National Hospital of Sri Lanka.

BACKGROUND: Inflammation in myocardial infarction has a complex immunogenic origin and is suspected to be closely involved in its aetio-pathogenesis as well as outcome. In this study the objective was to further elucidate the clinical correlations of inflammation using clinical parameters and basic inflammatory markers and how it correlates with patient risk parameters, imaging findings and outcome. METHODS: An observational descriptive cross sectional study was carried out at the Institute of Cardiology, National Hospital of Sri Lanka, where consenting patients presenting for further management of ST- elevation myocardial infarction were recruited. Venous blood samples were collected on admission to assess C-reactive protein levels and on a timed manner to asses Troponin I levels as well as on subsequent days to performs whole blood analysis. Patients underwent 6 hourly axillary temperature assessment. All patients underwent 2D transthoracic echocardiographic analysis via biplane Simpson's method to ascertain ejection fraction as well. RESULTS: Eighty eight subjects were recruited into the study. Fever was noted in 20.5% (n = 18). Fever was usually intermittent and seen commonly between day 1 and 3 post-acute myocardial infarction. Haematological abnormalities indicative of inflammation were also observed as whole blood analysis demonstrated predominant leukocytosis and elevated C-reactive protein levels. Significant correlation was noted between presence of leukocytosis (P = 0.033) and fever as well as with the presence of diabetes mellitus (P = 0.005). Development of acute heart failure also showed significant correlation with leukocytosis (P = 0.002). Correlation was also observed between LV dysfunction and elevated C-reactive protein and Troponin I levels with P values of P = 0.023 and P = 0.011 (P < 0.05) respectively. CONCLUSIONS: Inflammation is appreciated following acute myocardial infarction. Biochemical evidence of inflammation is commonly seen. Clinical manifestation as fever however is seen less often. Patient factors correlate poorly with inflammation but diabetes mellitus may have a contributory role. Whole blood analysis derangement is a simple test that correlates well with inflammation as well as presence of fever and development of heart failure. Inflammation also correlated with left ventricular dysfunction and may thus have an impact on clinical morbidity and mortality. Delineating associates of inflammation will hopefully help improve therapy of myocardial infarction.

Examining the Influence of E-Health Education on Professional Practice.

e-Health is steadily integrating into modern health services, making significant changes in the way health services are traditionally delivered. To work in this new environment, healthcare workers are required to have new knowledge, skills and competencies specific to e-Health. The aim of this study was to understand the self-reported perceptions of graduates regarding the influence of an e-Health postgraduate program on their professional careers. In addition, this paper will provide an overview of the e-Health postgraduate program. All graduates from 2005 to 2015 were surveyed using an online questionnaire that consisted of a mixture of closed and open-ended questions. The number of participants in the study was 32. Response rate was 62%. The main motivating factors for studying e-Health were 'relevance to current practice' and 'e-Health is the future'. The participants noted that the opportunity to 'acquiring relevant knowledge' and 'having exposure' were key benefits offered by the e-Health education program. The majority of graduates (n = 23, 72%) thought that the postgraduate e-Health program had an influence on their professional practice. A similar number of participants (n = 23, 72%) mentioned that they had worked in the field of e-Health since their graduation. Their professional roles mainly involved 'implementation of e-Health in health service settings' and the 'use of e-Health in clinical practice'. While e-Health may be steadily integrating into modern health services, e-Health specific job opportunities are still relatively limited. e-Health workforce development must be given priority.

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.

A cost-consequence analysis comparing patient travel, outreach, and telehealth clinic models for a specialist diabetes service to Indigenous people in Queensland.

INTRODUCTION: The delivery of specialist health services to people living in Indigenous communities is an important challenge. Specialist diabetes outpatient clinics may be delivered via a patient travelling to a metropolitan hospital, during an outreach clinic, or by telehealth. The aim of this study was to compare the costs and consequences of different service models for delivering specialist diabetes clinics for a remote Indigenous community. METHOD: Patient travel, outreach and telehealth clinic models were compared using a cost-consequence analysis principles. The setting was Cunnamulla, a remote Indigenous community in Western Queensland. Costs were calculated by quantifying the staff resources and travel costs for each clinic model. Costs were reported in Australian dollars and reported from the health service perspective. RESULTS: The marginal cost per patient for each clinic were $692 for patient travel, $482 for the outreach and $284 for telehealth. If a patient travel appointment was replaced with telehealth, approximately $517 in costs for patient travel reimbursement would be avoided. While replacing an entire outreach clinic with a telehealth clinic would reduce costs by approximately $3961. CONCLUSION: The marginal cost of patient travel to a metropolitan clinic and outreach clinic appointments was greater than telehealth. Telehealth is unlikely to completely replace the need for patient travel or outreach clinics. However, replacing a proportion of these appointments with telehealth may reduce the overall costs of providing specialist diabetes care in remote communities. Telehealth may have advantages beyond economic as it reduces the time away from usual activities for both the patient and endocrinologist.

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.

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.

Examining the social status, risk factors and lifestyle changes of tuberculosis patients in Sri Lanka during the treatment period: a cross-sectional study.

BACKGROUND: Tuberculosis (TB) is a major global health problem, commonly seen in underdeveloped countries. The probability of contracting the disease is significantly higher among the economically vulnerable and the socially disadvantaged. Risk factors associated with TB can also change over time. In the Sri Lankan context, no study has explored how these factors impact patients. Therefore, we aimed to explore social status, associated risk factors and lifestyle changes during the treatment period of TB patients attending a tertiary respiratory center in Colombo, Sri Lanka. METHODS: The descriptive cross-sectional study was conducted in 2011. The study population consisted of diagnosed tuberculosis patients above the age of 15 years. Patient records were retrieved from the TB patient registry for the Colombo district. Systematic sampling was used to identify patients to be invited to the study. An interviewer-administered questionnaire was used for data collection. Data were collected on social status (example, level of education, employment, and income), associated risk factors (example, smoking and alcohol consumption, contact history, narcotic drug use) and lifestyle changes during treatment (example, employment status, social interactions). The analysis included a logistic regression model to explore the association between social status and risk factors. RESULTS: The total number of patients included in the study was 425. Tuberculosis was found to be strongly prevalent among participants from the lower socio-economic status. It was also common in participants with a low level of education, unemployed, if employed, those who are engaged in unskilled employment and have low levels of income. Risk factors associated with the patients were smoking, alcohol consumptions, narcotic drug use, imprisonment, close contact history with active TB patients and chronic medical conditions. Changes in employment and the reduction of social-interactions were the main lifestyle changes of the participants occurred during the treatment period. The analysis also showed positive correlation between low-level social status and sputum smear infectivity, and use of dangerous drugs. Even after adjusting for confounders, tuberculosis negatively affected social interactions and income levels of participants from the low social status. CONCLUSION: Low socio-economic status negatively affected the lifestyle and social interactions of patients during the treatment period. Though competent treatment programs exist in Sri Lanka, it is still important to identify and mitigate risk factors associated with tuberculosis patients. A comprehensive multi-disciplinary approach considering patient lifestyle, and the implications of the disease and treatment on social interactions may strengthen the current preventive strategies.

It's important, but not important enough: eHealth as a curriculum priority in medical education in Australia.

Information and communications technology has become central to the way in which health services are provided. Technology-enabled services in healthcare are often described as eHealth, or more recently, digital health. Practitioners may require new knowledge, skills and competencies to make best use of eHealth, and while universities may be a logical place to provide such education and training, a study in 2012 found that the workforce was not being adequately educated to achieve competence to work with eHealth. We revisited eHealth education and training in Australian universities with a focus on medical schools; we aimed to explore the progress of eHealth in the Australian medical curriculum. We conducted a national interview study and interpretative phenomenological analysis with participants from all 19 medical schools in Australia; two themes emerged: (i) consensus on the importance of eHealth to current and future clinical practice; (ii) there are other priorities, and no strong drivers for change. Systemic problems inhibit the inclusion of eHealth in medical education: the curriculum is described as 'crowded' and with competing demands, and because accrediting bodies do not expect eHealth competence in medical graduates, there is no external pressure for its inclusion. Unless and until accrediting bodies recognise and expect competence in eHealth, it is unlikely that it will enter the curriculum; consequently the future workforce will remain unprepared.

Outcomes of using telehealth for the provision of healthcare to Aboriginal and Torres Strait Islander people: a systematic review.

OBJECTIVE: To examine reported outcomes of health services delivered by telehealth to Indigenous Australians. METHODS: Systematic review of the literature. Searches were conducted to identify articles that reported a telehealth service used to provide clinical services to Indigenous Australians. Articles were screened for inclusion using pre-defined criteria. Findings were synthesised narratively and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. RESULTS: 14 articles, describing 11 distinct telehealth services, were selected based on the inclusion criteria. Authors of included studies report that telehealth has improved social and emotional wellbeing, clinical outcomes and access to health services for Indigenous Australians. Further, it has reduced travel and improved screening rates. Indigenous people report positive perceptions of their telehealth interaction. CONCLUSION: Telehealth is used to address poor accessibility to health services and for targeted screening programs for at risk populations. Reported outcomes from existing services demonstrate the potential of telehealth for health service delivery for Indigenous Australians. Confidence in the findings of this review is reduced by the predominance of descriptive studies and small sample sizes in many of the included articles. IMPLICATIONS: Telehealth models of care facilitated through partnerships between Aboriginal community-controlled health services and public hospitals may improve both patient outcomes and access to specialist services for Indigenous people.

Enablers and barriers in providing telediabetes services for Indigenous communities: A systematic review.

A systematic review of studies which reported on telediabetes services within Indigenous communities was undertaken in June 2016. The aim of this study was to identify enablers and barriers associated with the delivery of telehealth services for diabetes care amongst Indigenous people. A total of 14 articles met the study inclusion criteria, reporting work in Canada, Australia, India, and the US. Key enablers included the use of cultural and spiritual elements, acknowledgement of local beliefs and traditions, and appropriate community engagement. The involvement of Indigenous health workers was also very important because of their role in communication in local language, helping clinicians understand the community, and the transportation of patients. The main barriers associated with telediabetes services were the potentially high fail-to-attend rates, lack of technical skills associated with the operation of telehealth equipment, and the lack of availability of local staff. Knowledge of the enablers and barriers associated with the delivery of healthcare services to Indigenous communities is important when planning a telediabetes service.

Low uptake of Pap smear testing among medical clinic attendees in a tertiary care hospital in Sri Lanka.

INTRODUCTION: The Papanicolaou (Pap) smear test is a safe and effective screening test for pre-invasive cervical cancer. The test is offered free of charge through well-woman clinics in Sri Lanka, but previous studies have shown poor awareness and uptake. METHODS: We used an interviewer administered validated questionnaire to conduct a cross sectional survey among ever-married women between the ages of 25 and 65 years attending a medical clinic at the National Hospital of Sri Lanka. We obtained data on socio-demographic characteristics, awareness/knowledge and uptake status of Pap smear testing. RESULTS: A total of 188/280 eligible women were interviewed (67.1%). Participant ages ranged from 29-65 years. Awareness about Pap smear testing was found in 111 (59.0%) women of whom 41 (36.9%) did not know that the Pap smear was used to detect pre-cancerous lesions. Only 34 (18.1%) subjects had ever had a Pap smear taken. Univariate associations related to Pap smear uptake were: prior awareness of the test (p<0.001), higher parity (p=0.022), and knowing someone with cervical carcinoma (p<0.001). Multivariate regression analysis confirmed the same as independent associations of test uptake (p<0.001, p=0.012, p=0.013 respectively). CONCLUSIONS: Knowledge regarding Pap smear testing was poor. Pap smear uptake was very low, and did not parallel prior knowledge, although knowledge did influence uptake. Parity and contact with patients with cervical cancer correlated with uptake. There is an urgent need to increase uptake through a multi-pronged campaign.