C-Reactive Protein (CRP) is Associated With Chronic Pain Independently of Biopsychosocial Factors.

Inflammation is linked with chronic pain but the extent to which this relationship is associated with biopsychosocial factors is not known. We investigated relationships between blood C-reactive protein (CRP) and regional chronic pain conditions adjusting for a large range and number of potential confounders. We performed cross-sectional analyses using the UK Biobank (N = 415,567) comparing CRP in people reporting any of 9 types of regional chronic pain with pain-free controls. Using logistic regression modelling, we explored relationships between CRP and the presence of chronic pain, with demographic, socioeconomic, psychological/lifestyle factors, and medical comorbidities as covariates. CRP was higher in chronic pain at any site compared with controls (Females: median [interquartile range] 1.60 mg/L [2.74] vs 1.17 mg/L [1.87], P < .001; Males: 1.44 mg/L [2.12] vs 1.15 mg/L [1.65], P < .001). In males, associations between CRP and all types of chronic pain were attenuated but remained significant after adjustment for biopsychosocial covariates (OR range 1.08-1.49, P ≤ .001). For females, adjusted associations between CRP and pain remained significant for most chronic pain types (OR range 1.07-1.34, P < .001) except for facial pain (OR 1.04, P = .17) and headache (OR 1.02, P = .07)-although these non-significant findings may reflect reduced sample size. The significant association between CRP and chronic pain after adjustment for key biopsychosocial confounders implicates an independent underlying biological mechanism of inflammation in chronic pain. The presence of yet unknown or unmeasured confounding factors cannot be ruled out. Our findings may inform better-targeted treatments for chronic pain. PERSPECTIVE: Using a large-scale dataset, this article investigates associations between chronic pain conditions and blood C-reactive protein (CRP), to evaluate the confounding effects of a range of biopsychosocial factors. CRP levels were higher in those with chronic pain versus controls after adjusting for confounders-suggesting a possible independent biological mechanism.

A cost-minimisation analysis comparing alternative telemedicine screening approaches for retinopathy of prematurity.

INTRODUCTION: Screening for retinopathy of prematurity (ROP) is an important procedure in the prevention of blindness in high-risk preterm infants. In the regionalised healthcare system of Queensland (Australia), outside of the major centres, some preterm infants are cared for in special care nurseries (SCNs). When necessary, infants in these nurseries who are at risk of ROP are transferred to a tertiary hospital for screening by paediatric ophthalmologists. The transport of preterm infants for eye examinations adds risk and incurs significant costs to the health system. Using a cost-minimisation approach, we aimed to compare the costs of the current ROP screening practice with two alternative telemedicine approaches. METHODS: We constructed a decision analytic model to estimate costs from a health service perspective with a five-year analysis horizon; activity data from a tertiary ROP screening service were used to inform the models. The three models assessed were: (a) a digital retinal photography (DRP)-equipped travelling nurse, (b) equipping SCNs with DRP, and providing training to local nurses, and (c) current practice of infant transfer. In all cases, the tertiary centre provides specialist ophthalmologic review. RESULTS: Of the three models, we estimated the most expensive option to be equipping SCNs with DRP and providing training to local nurses (AUD$4114/infant). We found that the current practice of transferring infants was the second most expensive (AUD$1021/infant). The most economical model was the specialist nurse travelling to each SCN with a portable DRP (AUD$363/infant). A sensitivity analysis, which assessed uncertainty and variability around the cost estimates, found that the ranking for the expected costs of the alternative models of care did not change. DISCUSSION: This is the first economic and cost-minimisation analysis in Australia to compare the costs of the current screening programme with two alternative telemedicine approaches for screening ROP. Telemedicine programmes that facilitate non-physician screening may improve the cost efficiency of the health system while maintaining the health outcomes for children, and reducing the risk associated with infant transport.

The Origins and Evolution of the Field of Masculinity and Suicide: A Bibliometric and Content Analysis of the Research Field.

BACKGROUND: In most countries, men complete suicide at twice the rate of women; masculinity plays an important role in placing men at a greater risk of suicide. This study identifies and describes trends in the topics discussed within the masculinity and suicide literature and explores changes over time. METHODS: We retrieved publications relating to masculinity and suicide from eight electronic databases and described origins in the field of research by reference to the first decade of publications. We then explored the subsequent evolution of the field by analysis of the content of article titles/abstracts for all years since the topic first emerged, and then separately by three epochs. RESULTS: We included 452 publications (1954-2021); research output has grown substantially in the last five years. Early publications framed suicide in the context of severe mental illness, masculinity as a risk factor, and suicidality as being aggressive and masculine. We observed some differences in themes over time: Epoch 1 focused on sex differences in suicidality, a common theme in epochs 2 was relationship to work and its effect on men's mental health and suicidality, and epoch 3 had a focus on help-seeking in suicidality. CONCLUSION: The research field of masculinity and suicide is growing strongly, as evidenced by recent increase in publication volume. The structure, content and direction of the masculinity and suicide research are still evolving. Researchers must work with policymakers and practitioners to ensure that emerging findings are translated for use in programs designed to address suicide in boys and men.HIGHLIGHTSMasculinity and suicide as a field is not new, with its origins in the literature dating back to 1954.More than half of the total research output in the field (1954-2021) has been published in the last five years.Early work focused on individual-level risk factors to male suicide (e.g., severe mental illness), while contemporary research focused on social and cultural determinants of male suicide (e.g., help-seeking).

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.

A randomised controlled trial of implementation of a guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): Statistical analysis plan.

BACKGROUND: Statistical analysis plans describe the processes of data handling and analysis in clinical trials; by doing so they increase the transparency of the analysis and reporting of studies. This paper reports the planned statistical analysis plan for the Whiplash ImPaCT study. For individuals with whiplash injury, Whiplash ImPaCT aims to assess the effectiveness of a guidelines-based clinical pathway of care compared with usual care. METHODS: We report the planned procedures, methods, and reporting for the primary and secondary analyses of the Whiplash ImPaCT study. The primary outcomes are Global Recovery and Neck Disability Index at 3 months post-randomisation. Outcomes will be analysed according to the intention to treat principle using linear mixed models. A cost-utility analysis will be conducted to compute the incremental cost-effectiveness of the intervention to usual care. We describe data handling, our analytical approach, assumptions about missing data, and our planned methods of reporting. DISCUSSION: This paper will provide a detailed description of the planned analyses for the Whiplash ImPaCT trial.

Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials.

OBJECTIVE: To compare the effectiveness of different physical exercise interventions for chronic non-specific neck pain. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: Electronic databases: AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Physiotherapy Evidence Database, PsycINFO, Scopus and SPORTDiscus. ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) describing the effects of any physical exercise intervention in adults with chronic non-specific neck pain. RESULTS: The search returned 6549 records, 40 studies were included. Two networks of pairwise comparisons were constructed, one for pain intensity (n=38 RCTs, n=3151 participants) and one for disability (n=29 RCTs, n=2336 participants), and direct and indirect evidence was obtained. Compared with no treatment, three exercise interventions were found to be effective for pain and disability: motor control (Hedges' g, pain -1.32, 95% CI: -1.99 to -0.65; disability -0.87, 95% CI: -1.45 o -0.29), yoga/Pilates/Tai Chi/Qigong (pain -1.25, 95% CI: -1.85 to -0.65; disability -1.16, 95% CI: -1.75 to -0.57) and strengthening (pain -1.21, 95% CI: -1.63 to -0.78; disability -0.75, 95% CI: -1.28 to -0.22). Other interventions, including range of motion (pain -0.98 CI: -2.51 to 0.56), balance (pain -0.38, 95% CI: -2.10 to 1.33) and multimodal (three or more exercises types combined) (pain -0.08, 95% CI: -1.70 to 1.53) exercises showed uncertain or negligible effects. The quality of evidence was very low according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. CONCLUSION: There is not one superior type of physical exercise for people with chronic non-specific neck pain. Rather, there is very low quality evidence that motor control, yoga/Pilates/Tai Chi/Qigong and strengthening exercises are equally effective. These findings may assist clinicians to select exercises for people with chronic non-specific neck pain. PROSPERO REGISTRATION NUMBER: CRD42019126523.

Patient-Reported Experiences After Hysterectomy: A Cross-Sectional Study of the Views of Over 2300 Women.

OBJECTIVE: To evaluate women's experiences after hysterectomy and predictors of their contentment and regret with the surgical approaches. METHODS: Cross-sectional, Patient-Reported Experience Measures survey in 2319 Australian women aged 21 to 90 years (median age of 52 years) who had received hysterectomy in the preceding 2 years. RESULTS: Overall, the vast majority of women (>96%) did not regret having had the hysterectomy. Women who received an open abdominal hysterectomy reported slower recovery with about 7% of women still not fully recovered after 12 months compared to those whose surgery was through a less invasive approach. Women who reported no adverse events, having been given a choice of type of hysterectomy, women who received an alternative to open abdominal hysterectomy, and women who felt prepared for discharge from hospital were significantly more likely to be content with their hysterectomy and report positive patient experiences. CONCLUSIONS: Compared with those who received a less invasive approach to hysterectomy, women who received open surgery were more likely to express negative experiences relating to their hospital stay and recovery from surgery. The results inform future improvements of care for women planning a hysterectomy.

Correction: Cost-effectiveness analysis of a mobile ear screening and surveillance service versus an outreach screening, surveillance and surgical service for indigenous children in Australia.

[This corrects the article DOI: 10.1371/journal.pone.0138369.].

The comparative effectiveness of physical exercise interventions in individuals with chronic non-specific neck pain: protocol for a network meta-analysis.

INTRODUCTION: Neck pain is a global burdensome problem, with a large proportion of neck pain cases becoming chronic. Although physical exercise is a commonly prescribed treatment, the evidence on the effectiveness of isolated exercise interventions remains limited. Traditional pairwise randomised controlled trials (RCTs) and meta-analyses are limited in only comparing two interventions. This protocol describes the design of a network meta-analysis, which enables a comparative investigation of all physical exercise interventions for which RCTs are available. We aim to systematically compare the effectiveness of different types of physical exercise in people with chronic non-specific neck pain. METHODS AND ANALYSIS: Nine electronic databases (AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Physiotherapy Evidence Database, PsycINFO, Scopus and SPORTDiscus) were searched for RCTs from inception to 12 March 2019. Titles and abstract firstly, and full-text papers secondly, will be screened by two reviewers. Data will be extracted by two reviewers. The primary outcome measure is effectiveness of the intervention. Methodological quality of included studies will be assessed by two reviewers using the PEDro scale. The overall quality of evidence will be assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, which has been adapted for network meta-analyses. The available evidence will be summarised using a network diagram. A contribution matrix will be presented to allow assessment of direct and indirect evidence. Forest plots will be constructed to visualise effects of all included exercise interventions. Pairwise effect sizes will be calculated by including all evidence available in the network. Effect measures for treatments that have not been compared in a pairwise RCT can be compared indirectly by contrasting effect sizes of comparisons with a common comparator. ETHICS AND DISSEMINATION: This work synthesises evidence from previously published studies and does not require ethics review or approval. A manuscript describing the findings will be submitted for publication in a peer-reviewed scientific journal. PROSPERO REGISTRATION NUMBER: CRD42019126523.

The mechanisms of effect of a physiotherapist-delivered integrated psychological and exercise intervention for acute whiplash-associated disorders: secondary mediation analysis of a randomized controlled trial.

INTRODUCTION: Integrated psychological and physical treatments can improve recovery for whiplash-associated disorders (WADs). Little is known about how these interventions work. OBJECTIVE: To examine the mechanisms by which a physiotherapist-delivered integrated intervention for acute WAD improves health outcomes. METHODS: Secondary analysis using structural equation modelling of a randomized controlled trial comparing integrated stress inoculation training and exercise to exercise alone for acute WAD. Outcomes were disability, pain self-efficacy, pain intensity, and health-related quality of life at 12 months. The intended intervention target and primary mediator, stress was tested in parallel with pain-related coping, an additional cognitive behavioral mediator that significantly improved at posttreatment (Model 1). Stress-related constructs that commonly co-occur with stress and pain were also tested as parallel mediators: depression and pain-related coping (Model 2); and posttraumatic stress and pain-related coping (Model 3). RESULTS: Reductions in stress mediated the effect of the integrated intervention on disability (ß = -0.12, confidence interval [CI] = -0.21 to -0.06), pain self-efficacy (ß = 0.09, CI = 0.02-0.18), pain (ß = -0.12, CI = -0.21 to -0.06), and health-related quality of life (ß = 0.11, CI = 0.04-0.21). There was an additional path to pain self-efficacy through pain-related coping (ß = 0.06, CI = 0.01-0.12). Similar patterns were found in Models 2 and 3. CONCLUSIONS: Improvements in stress and related constructs of depression and posttraumatic stress, and pain-related coping were causal mechanisms of effect in a physiotherapist-delivered integrated intervention. As integrated interventions are growing in popularity, it is important to further personalize interventions for improved benefit.

Queensland Telepaediatric Service: A Review of the First 15 Years of Service.

In November 2000, the Queensland Telepaediatric Service (QTS) was established in Brisbane, Australia, to support the delivery of telehealth services to patients and clinicians in regional and remote locations. The QTS was built on a centralized coordination model, where telehealth services could be effectively managed by a dedicated telehealth coordinator. In doing so, telehealth referral and consultation processes were efficient and clinicians felt better supported as they adjusted to new processes for engaging with patients. We have conducted a retrospective review of activity associated with the QTS and summarized key activities which have arisen from this extensive program of work. Telehealth service records and associated publications were used to describe the evolution of the QTS over a 15-year period. From November 2000 to March 2016, 23,054 telehealth consultations were delivered for 37 pediatric clinical specialties. The most common service areas included child and youth mental health, neurology, burns care, surgery, and ear nose and throat services. A range of different telehealth service models were developed to align with different clinical service needs and location of services. Whilst most work involved video consultation between hospitals, some services involved the delivery of telehealth services into the home, schools or community health centres. Despite its longevity, the QTS was not immune to the usual challenges associated with telehealth implementation, service redesign and sustainability. Experience reported from the QTS will be useful for other health services seeking to develop comprehensive telehealth services in a rapidly changing healthcare environment.

How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial.

INTRODUCTION: Hysterectomy is the most common major gynaecological procedure in women and minimally invasive approaches should be used wherever possible; total laparoscopic hysterectomy (TLH) is one such surgical approach which allows removal of the uterus entirely laparoscopically. However, lack of surgical training opportunities is impeding its increased adoption. This study will formally test a surgical outreach training model to equip surgeons with the skills to provide TLH as an alternative to total abdominal hysterectomy (TAH). METHODS AND ANALYSIS: Stepped wedge implementation trial of a surgical training programme for practising obstetrician gynaecologist specialists in four hospitals. PRIMARY OUTCOMES: Change in the proportion of hysterectomies performed by TAH, measured between preintervention and postintervention; we aim to reduce TAH by at least 30% in 75% of the trainees. SECONDARY OUTCOMES: (1) Number of hospitals screened, eligible, agree to training and complete the training; (2) number of surgeons screened for eligibility, eligible, agree to training, who complete training and achieve proficiency; (3) proportion of trainees achieving proficiency in correct theatre setup, vascular exposure, mobilisation and surgery closure; change in proportion proficient over time; (4) adverse events (conversion from TLH to TAH, anaesthetic incident, intraoperative visceral injury, red cell transfusions, hospital stay >7 days, incidental finding of malignancy, unplanned readmission, admission to intensive care, return to theatre, postoperative pulmonary embolism or deep vein thrombosis, development of a fistula, vault haematoma, vaginal vault dehiscence or pelvic infection); (5) hospital length-of-stay; (6) cost-effectiveness and (7) trainee surgeon proficiency with TLH. ETHICS AND DISSEMINATION: The study has been approved by the Royal Brisbane and Women's Hospital Human Research Ethics Committee and has received site-specific approval from all participating hospitals. Results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT03617354; Pre-results.

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.

The use of telemedicine for delivering healthcare to bariatric surgery patients: A literature review.

Introduction Bariatric weight loss surgery is one of the most effective treatments for severe obesity. Research shows that the availability of healthcare services pre and post bariatric surgery improves behavioural change and weight loss outcomes. The aim of this systematic review is to assess the evidence relating to the use of telemedicine for providing health services to bariatric surgery patients. Methods A search was conducted using PubMed, EMBASE, CINAHL, PsycNET and SCOPUS. Original research relating to telemedicine for bariatric surgery patients published in peer-reviewed journals were included. Results Database search returned 258 references and a total of 10 studies were included in the review. Six studies assessed use, feasibility and acceptance of telemedicine by patients/practitioners. Studies also examined the use of telemedicine for weight loss, changes in physical activity, diet/eating or other behavioural changes. Two studies were randomised controlled trials; one showed a significant difference in outcomes between intervention and control group. Discussion This review suggests that telemedicine may be a potential method for providing healthcare services to bariatric surgery patients. However, the current evidence base does not allow for definitive conclusions.

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.

The effectiveness of telemedicine interventions to address maternal depression: A systematic review and meta-analysis.

Introduction Maternal depression (MD), is an overarching term for depression affecting pregnant women and mothers for up to 12 months postpartum. Because MD may have chronic and long-lasting effects, it is an important public health concern. The extent to which telemedicine may be an effective way to provide services to sufferers of MD is unknown, therefore, this review aimed to assess the available evidence. Methods We conducted a search of The Cochrane Library, PubMed/MEDLINE, PsycINFO, and EMBASE for relevant randomised controlled trials published between 2000 and 2018; we then conducted a systematic review and meta-analysis. Results We identified 10 studies for inclusion. Therapeutic strategies involved cognitive behavioural therapy (CBT), behavioural activation and other psychoeducation. Eight trials reported significant improvement in depression scores post-intervention; four studies that conducted post-intervention follow-up found that these improvements continued. However, high attrition rates and lack of blinding were common problems. Discussion This review found limited evidence supporting the delivery of CBT for the treatment of MD and anxiety using telemedicine. However, most of the evidence only studied improvements in postpartum depression, indicating that use of telemedicine to provide MD intervention is still small and an under-researched area.

Surgical approach to hysterectomy and barriers to using minimally invasive methods.

Minimally invasive approaches to hysterectomy have been shown to be safe, effective and have recovery advantages over open hysterectomy, yet in Australia 36% of hysterectomies are still conducted by open surgery. In 2006, a survey of Australian gynaecological specialists found the main impediment to increasing laparoscopic hysterectomy to be a lack of surgical skills training opportunities. We resurveyed specialists to explore contemporary factors influencing surgeons' approaches to hysterectomy; 258 (estimated ~19%) provided analysable responses. Despite >50% of surveyed specialists wishing to practise laparoscopic hysterectomy in the future, lack of surgical skills, arising from the lack of training opportunities, remains the main impediment.

Factors influencing women's decision making in hysterectomy.

OBJECTIVE: To explore factors influencing how well-informed women felt about hysterectomy, influences on their decision making, and on them receiving a less-invasive alternative to open surgery. METHODS: Online questionnaire, conducted in 2015-2016, of women who had received a hysterectomy in Australia, in the preceding two years. RESULTS: Questionnaires were completed by 2319/6000 women (39% response). Most women (n=2225; 96%) felt well-informed about hysterectomy. Women were more aware of the open abdominal approach (n=1798; 77%), than of less-invasive vaginal (n=1552; 67%), laparoscopic (n=1540; 66%), laparoscopic-assisted (n=1303; 56%), and robotic approaches (n=289; 12%). Most women (n=1435; 62%) reported their gynaecologist was the most influential information source. Women who received information about hysterectomy from a GP (OR=1.47; 95% CI 1.15-1.90), or from a gynaecologist (OR=1.3; 95% CI 1.06-1.58), were more likely to feel better informed (p<0.01). CONCLUSION: This study is important because it helps clinicians, researchers and health policy makers to understand why many women still receive an open abdominal approach despite many learned societies recommending to avoid it if possible. PRACTICE IMPLICATIONS: Additional information, or education about avoiding open abdominal approach where possible may lead to a greater number of women receiving less-invasive types of hysterectomy in the future.

Assessment of Self-Perceived Knowledge in e-Health Among Undergraduate Students.

OBJECTIVE: Growing research evidence shows the value of e-health in healthcare delivery. While efforts are made to implement e-health in mainstream healthcare, relatively modest attention has been paid to develop e-health knowledge and skills in health practitioners. Using a pre-post design, in this study, we aimed to examine self-reported knowledge and perception changes associated with an e-health course offered to university undergraduate students in Australia. METHODS: Pre- and postsurveys were used to examine self-reported knowledge and perception changes relating to e-health among undergraduate students. All students enrolled in an e-health course (n = 165) were asked to complete an identical survey in the first and last week of the semester. RESULTS: The response rates were 53% (n = 87) for the presurvey and 52% (n = 85) for the postsurvey. For all items, changes in self-reported knowledge and perception were statistically significant in pre/post median scores and dichotomized negative/positive proportions. CONCLUSIONS: Students believed the course helped them to improve their knowledge regarding key aspects of e-health. It is important to design an e-health curriculum targeting competencies to provide necessary knowledge and skills to help students practice e-health in their professional careers.