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Zhu Z, Geng Y, Ma L, Yao K, Chang R, Ma Y, Li J. Association between CBS gene T833C, G919A and 844ins68 polymorphisms in the 8th exon region and coronary artery disease: a meta-analysis. Clin Exp Hypertens 2024; 46:2328147. [PMID: 38488417 DOI: 10.1080/10641963.2024.2328147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Several studies indicate that the cystathionine β-synthase (CBS) gene T833C, G919A and 844ins68 polymorphisms in the 8th exon region may be correlated with coronary artery disease (CAD) susceptibility, but the results have been inconsistent and inconclusive. Thus, a meta-analysis was conducted to provide a comprehensive estimate of these associations. METHODS On the basis of searches in the PubMed, EMBASE, Cochrane Library, Wanfang, VIP, and CNKI databases, we selected 14 case - control studies including 2123 cases and 2368 controls for this meta-analysis. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated accordingly using a fixed-effect or random-effect model. RESULTS The results indicated an increased risk between the CBS T833C gene polymorphisms and susceptibility to CAD under the dominant model (CC+CT vs. TT: OR = 1.92, 95% CI: 1.11 ~ 3.32), recessive model (CC vs. CT+TT: OR = 1.88, 95% CI: 1.17 ~ 3.03), and homozygous model (CC vs. TT: OR = 2.46, 95% CI: 1.04 ~ 5.83). In these three genetic models, no significant association was identified for CBS G919A (AA+AG vs. GG: OR = 1.48, 95% CI: 0.45 ~ 4.82),(AA vs. AG+GG: OR = 1.58, 95% CI: 0.93 ~ 2.70),(AA vs. GG: OR = 1.66, 95% CI: 0.40 ~ 6.92) or CBS 844ins68 (II+ID vs. DD: OR = 1.04, 95% CI: 0.80 ~ 1.35),(II vs. ID+DD: OR = 1.09, 95% CI: 0.51 ~ 2.36),(II vs. DD: OR = 1.10, 95% CI: 0.51 ~ 2.39). CONCLUSIONS This meta-analysis suggests that the CBS T833C gene polymorphism is significantly associated with the risk of CAD and it shows a stronger association in Asian populations. Individuals with the C allele of the CBS gene T833C polymorphism might be particularly susceptible to CAD.
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Affiliation(s)
- Zijiang Zhu
- Department of thoracic surgery, Gansu Provincial Central Hospital (Gansu Provincial Maternity and Child-care Hospital), Lanzhou, China
| | - Yuhan Geng
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Long Ma
- Department of thoracic surgery, Gansu Provincial Central Hospital (Gansu Provincial Maternity and Child-care Hospital), Lanzhou, China
- Department of thoracic surgery, Gansu University of Chinese Medicine, Lanzhou, China
| | - Keying Yao
- School of Second Clinical Medical, Lanzhou University, Lanzhou, China
| | - Ruitong Chang
- Department of thoracic surgery, Gansu Provincial Central Hospital (Gansu Provincial Maternity and Child-care Hospital), Lanzhou, China
| | - Yongming Ma
- Department of thoracic surgery, Gansu Provincial Central Hospital (Gansu Provincial Maternity and Child-care Hospital), Lanzhou, China
- Department of thoracic surgery, Gansu University of Chinese Medicine, Lanzhou, China
| | - Jialong Li
- Department of thoracic surgery, Gansu Provincial Central Hospital (Gansu Provincial Maternity and Child-care Hospital), Lanzhou, China
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Joubert A, Reid M. Knowledge, skills, and training of community health workers to contribute to interprofessional education: a scoping review. J Interprof Care 2024; 38:308-318. [PMID: 36821383 DOI: 10.1080/13561820.2023.2176472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 10/12/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023]
Abstract
A scoping review of 32 publications was conducted with the aim of mapping literature to determine what is known about the knowledge, skills, and training of community health workers that could contribute to interprofessional education. Interprofessional education, as a pedagogical approach, prepares health professions students to serve patients in collaboration with other health professionals to improve patient outcomes. All over the world, the role of community health workers is vital for its support of community service and community health outcomes. However, no evidence could be found on the knowledge, skills, and training of community health workers that contribute to interprofessional education. The knowledge that community health workers need to contribute to interprofessional education, as reported by the literature, relates to case management, communication, health education, recordkeeping and referrals. Skills, such as critical thinking, interprofessional collaboration, and various clinical procedures, were noted. Training approaches reported included the use of technology such as mobile phones and web-based learning. The scoping review improved our understanding of the knowledge, skills, and training of community health workers that could contribute to interprofessional education. Applying a fit-for-purpose approach, and building on existing knowledge, skills, and training, could fast-track the contribution of community health workers to interprofessional education.
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Affiliation(s)
- Annemarie Joubert
- School of Nursing, University of the Free State, Bloemfontein, South Africa
| | - Marianne Reid
- School of Nursing, University of the Free State, Bloemfontein, South Africa
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Lee DN, Sadasivam RS, Stevens EM. Developing Mood-Based Computer-Tailored Health Communication for Smoking Cessation: Feasibility Randomized Controlled Trial. JMIR Form Res 2023; 7:e48958. [PMID: 38133916 PMCID: PMC10770788 DOI: 10.2196/48958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Computer-tailored health communication (CTHC), a widely used strategy to increase the effectiveness of smoking cessation interventions, is focused on selecting the best messages for an individual. More recently, CTHC interventions have been tested using contextual information such as participants' current stress or location to adapt message selection. However, mood has not yet been used in CTCH interventions and may increase their effectiveness. OBJECTIVE This study aims to examine the association of mood and smoking cessation message effectiveness among adults who currently smoke cigarettes. METHODS In January 2022, we recruited a web-based convenience sample of adults who smoke cigarettes (N=615; mean age 41.13 y). Participants were randomized to 1 of 3 mood conditions (positive, negative, or neutral) and viewed pictures selected from the International Affective Picture System to induce an emotional state within the assigned condition. Participants then viewed smoking cessation messages with topics covering five themes: (1) financial costs or rewards, (2) health, (3) quality of life, (4) challenges of quitting, and (5) motivation or reasons to quit. Following each message, participants completed questions on 3 constructs: message receptivity, perceived relevance, and their motivation to quit. The process was repeated 30 times. We used 1-way ANOVA to estimate the association of the mood condition on these constructs, controlling for demographics, cigarettes per day, and motivation to quit measured during the pretest. We also estimated the association between mood and outcomes for each of the 5 smoking message theme categories. RESULTS There was an overall statistically significant effect of the mood condition on the motivation to quit outcome (P=.02) but not on the message receptivity (P=.16) and perceived relevance (P=.86) outcomes. Participants in the positive mood condition reported significantly greater motivation to quit compared with those in the negative mood condition (P=.005). Participants in the positive mood condition reported higher motivation to quit after viewing smoking cessation messages in the financial (P=.03), health (P=.01), quality of life (P=.04), and challenges of quitting (P=.03) theme categories. We also compared each mood condition and found that participants in the positive mood condition reported significantly greater motivation to quit after seeing messages in the financial (P=.01), health (P=.003), quality of life (P=.01), and challenges of quitting (P=.01) theme categories than those in the negative mood condition. CONCLUSIONS Our findings suggest that considering mood may be important for future CTHC interventions. Because those in the positive mood state at the time of message exposure were more likely to have greater quitting motivations, smoking cessation CTHC interventions may consider strategies to help improve participants' mood when delivering these messages. For those in neutral and negative mood states, focusing on certain message themes (health and motivation to quit) may be more effective than other message themes.
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Affiliation(s)
- Donghee N Lee
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, Division of Health Informatics and Implementation Science, UMass Chan Medical School, Worchester, MA, United States
| | - Elise M Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, MA, United States
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Xu M, Guo K, Shang X, Zhou L, E F, Yang C, Wu Y, Li X, Yang K. Network Meta-Analysis of Behavioral Programs for Smoking Cessation in Healthy People. Am J Prev Med 2023; 65:327-336. [PMID: 36893951 DOI: 10.1016/j.amepre.2023.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Smoking is a risk factor for most chronic diseases and premature death, with a global prevalence of more than 1 billion people who smoke. This network meta-analysis aimed to investigate the impact of different behavioral interventions on smoking cessation. METHODS Four electronic databases were searched for RCTs from inception to August 29, 2022. The risk of bias for the included RCTs was evaluated using the revised version of Cochrane tool for assessing risk of bias and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The network meta-analysis was performed using Stata 16SE and R 4.1.3 software. RESULTS A total of 119 included RCTs enrolled 118,935 participants. For the 7-day-point prevalence abstinence rate, video counseling had a best intervention effect than brief advice, followed by financial incentives, self-help materials plus telephone counseling, motivational interview, health education, telephone counseling, and text messages. For the 30-day-point prevalence abstinence rate, face-to-face cognitive education and financial incentives were superior to brief advice. For the continuous abstinence rate, motivational interview and financial incentives were more effective than brief advice. The certainty of evidence was very low to moderate for these studies. DISCUSSION From the results of the network meta-analysis, different behavioral interventions resulted in positive impacts on smoking cessation compared with that of brief advice, especially video counseling, face-to-face cognitive education, and motivational interviews. Owing to the poor quality of evidence, high-quality trials should be conducted in the future to provide more robust evidence.
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Affiliation(s)
- Meng Xu
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| | - Kangle Guo
- Gansu Provincial Hospital, Lanzhou, China
| | - Xue Shang
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Liying Zhou
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Fenfen E
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Chaoqun Yang
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Yanan Wu
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xiuxia Li
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| | - Kehu Yang
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
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Chang Y, Cui Z, He X, Zhou X, Zhou H, Fan X, Wang W, Yang G. Effect of unifaceted and multifaceted interventions on antibiotic prescription control for respiratory diseases: A systematic review of randomized controlled trials. Medicine (Baltimore) 2022; 101:e30865. [PMID: 36254082 PMCID: PMC9575778 DOI: 10.1097/md.0000000000030865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The global health system is improperly using antibiotics, particularly in the treatment of respiratory diseases. We aimed to examine the effectiveness of implementing a unifaceted and multifaceted intervention for unreasonable antibiotic prescriptions. METHODS Relevant literature published in the databases of Pubmed, Embase, Science Direct, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure and Wanfang was searched. Data were independently filtered and extracted by 2 reviewers based on a pre-designed inclusion and exclusion criteria. The Cochrane collaborative bias risk tool was used to evaluate the quality of the included randomized controlled trials studies. RESULTS A total of 1390 studies were obtained of which 23 studies the outcome variables were antibiotic prescription rates with the number of prescriptions and intervention details were included in the systematic review. Twenty-two of the studies involved educational interventions for doctors, including: online training using email, web pages and webinar, antibiotic guidelines for information dissemination measures by email, postal or telephone reminder, training doctors in communication skills, short-term interactive educational seminars, and short-term field training sessions. Seventeen studies of interventions for health care workers also included: regular or irregular assessment/audit of antibiotic prescriptions, prescription recommendations from experts and peers delivered at a meeting or online, publicly reporting on doctors' antibiotic usage to patients, hospital administrators, and health authorities, monitoring/feedback prescribing behavior to general practices by email or poster, and studies involving patients and their families (n = 8). Twenty-one randomized controlled trials were rated as having a low risk of bias while 2 randomized controlled trials were rated as having a high risk of bias. Six studies contained negative results. CONCLUSION The combination of education, prescription audit, prescription recommendations from experts, public reporting, prescription feedback and patient or family member multifaceted interventions can effectively reduce antibiotic prescription rates in health care institutions. Moreover, adding multifaceted interventions to educational interventions can control antibiotic prescription rates and may be a more reasonable method. REGISTRATIONS This systematic review was registered in PROSPERO, registration number: CRD42020192560.
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Affiliation(s)
- Yue Chang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
| | - Zhezhe Cui
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China
| | - Xun He
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
| | - Xunrong Zhou
- The Second Affiliated Hospital, Guizhou University of Chinese Medicine, Guiyang, China
| | - Hanni Zhou
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
| | - Xingying Fan
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
| | - Wenju Wang
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Guanghong Yang
- School of Public Health, Guizhou Medical University, Guiyang, China
- *Correspondence: Guanghong Yang, School of Public Health, Guizhou Medical University, Guiyang, China (e-mail: )
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K Zhang K, Thompson AW. Effectiveness of electronic learning for continuing interprofessional education on behavior change of healthcare professionals: A scoping review. J Interprof Care 2022:1-11. [PMID: 35880763 DOI: 10.1080/13561820.2022.2071850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Electronic learning (e-learning) for continuing professional education (CPE) in healthcare has been shown to improve learners' satisfaction, attitudes, and performance. E-learning outcomes for continuing interprofessional education (CIPE) are less known, and the features of electronic CIPE programs that promote behavior change are unclear. In this scoping review, we sought to identify the program features and areas of behavior change in healthcare professionals using e-learning for CIPE. PubMed, CINAHL, ERIC, PsycINFO, Cochrane Library databases, and Google/Google Scholar were searched for all English articles published in the last 10 years. From the 32 studies included in our review, eight types of e-learning methods were identified. More than 35,542 healthcare professionals of different professions had participated in the programs. Thirty studies demonstrated positive behavior changes, with four areas of behavior changes identified. The most common area of change was in patient care practices. Five common program features facilitating behavior change were also identified. Most successful programs provided interactive and authentic learning experiences, which promoted direct clinical application. Future researche should include monitoring of sustained behavior changes at work, linked to patient outcomes.
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Affiliation(s)
- Karen K Zhang
- Orthoptic Department, Singapore National Eye Centre, Singapore
| | - Anne W Thompson
- MGH Institute of Health Professions, Boston, Massachusetts, United States of America
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Zheng K, Xie Y, Dan L, Mao M, Chen J, Li R, Wang X, Hesketh T. Effectiveness of Educational Interventions for Health Workers on Antibiotic Prescribing in Outpatient Settings in China: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2022; 11:antibiotics11060791. [PMID: 35740197 PMCID: PMC9220158 DOI: 10.3390/antibiotics11060791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 02/01/2023] Open
Abstract
Educational interventions are considered an important component of antibiotic stewardship, but their effect has not been systematically evaluated in outpatient settings in China. This research aims to evaluate the effectiveness of educational interventions for health workers on antibiotic prescribing rates in Chinese outpatient settings. Eight databases were searched for relevant randomized clinical trials, non-randomized trials, controlled before–after studies and interrupted time-series studies from January 2001 to July 2021. A total of 16 studies were included in the systematic review and 12 in the meta-analysis. The results showed that educational interventions overall reduced the antibiotic prescription rate significantly (relative risk, RR 0.72, 95% confidence interval, CI 0.61 to 0.84). Subgroup analysis demonstrated that certain features of education interventions had a significant effect on antibiotic prescription rate reduction: (1) combined with compulsory administrative regulations (RR With: 0.65 vs. Without: 0.78); (2) combined with financial incentives (RR With: 0.51 vs. Without: 0.77). Educational interventions can also significantly reduce antibiotic injection rates (RR 0.83, 95% CI 0.74 to 0.94) and the inappropriate use of antibiotics (RR 0.61, 95% CI 0.51 to 0.73). The limited number of high-quality studies limits the validity and reliability of the results. More high-quality educational interventions targeting the reduction of antibiotic prescribing rates are needed.
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Affiliation(s)
- Kunhua Zheng
- People’s Hospital of Kaihua, Quzhou 324300, China; (K.Z.); (M.M.)
| | - Ying Xie
- Center for Global Health, Zhejiang University School of Medicine, Hangzhou 310000, China; (Y.X.); (L.D.); (J.C.); (R.L.); (T.H.)
| | - Lintao Dan
- Center for Global Health, Zhejiang University School of Medicine, Hangzhou 310000, China; (Y.X.); (L.D.); (J.C.); (R.L.); (T.H.)
| | - Meixian Mao
- People’s Hospital of Kaihua, Quzhou 324300, China; (K.Z.); (M.M.)
| | - Jie Chen
- Center for Global Health, Zhejiang University School of Medicine, Hangzhou 310000, China; (Y.X.); (L.D.); (J.C.); (R.L.); (T.H.)
| | - Ran Li
- Center for Global Health, Zhejiang University School of Medicine, Hangzhou 310000, China; (Y.X.); (L.D.); (J.C.); (R.L.); (T.H.)
- Institute for Global Health, University College London, London WC1E 6BT, UK
| | - Xuanding Wang
- Department of Antimicrobial Stewardship, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China
- Correspondence:
| | - Therese Hesketh
- Center for Global Health, Zhejiang University School of Medicine, Hangzhou 310000, China; (Y.X.); (L.D.); (J.C.); (R.L.); (T.H.)
- Institute for Global Health, University College London, London WC1E 6BT, UK
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Mc Veigh C, Carlisle S, Birch M, Ace L, Oliver C, Kerr H. Pilot study to explore the use of mobile spaced learning as a digital learning platform when teaching symptom management to undergraduate nursing students: SPLENdidS study. PLoS One 2022; 17:e0269633. [PMID: 35675374 PMCID: PMC9176778 DOI: 10.1371/journal.pone.0269633] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background The management of patients’ holistic symptom needs are often complex and challenging. The education needs of undergraduate nursing students must be optimally addressed to have a significant positive impact on patient care. Mobile spaced learning has been recognised as a form of online education which can provide a novel approach to delivering effective evidence based healthcare education to undergraduate students. Objective The objective of this pilot study was to explore the experiences of undergraduate nursing students in a university setting, of using mobile spaced learning as a digital platform for symptom management education. Method This pilot study used a mixed methods approach. Online spaced learning material, which utilised both case based scenarios and multiple choice questions, was delivered to first year undergraduate nursing students over a period of 2 weeks. Participants were then invited to participate in an online survey related to the usability of mobile spaced learning. A focus group was conducted to further explore the participants’ views. Result Findings conveyed that students viewed mobile spaced learning as an acceptable platform that enhanced both their learning and their ability to transfer knowledge into clinical practice. Conclusion Implementation of a digital spaced learning intervention would be acceptable to undergraduate nursing students learning about holistic symptom management. Further research is needed to explore the feasibility of implementing this intervention within the undergraduate nursing curriculum, and also to explore the impact on long-term knowledge retention.
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Affiliation(s)
- Clare Mc Veigh
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
- * E-mail:
| | - Susan Carlisle
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
| | - Matt Birch
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
| | - Lindsay Ace
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
| | - Christine Oliver
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
| | - Helen Kerr
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
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Shen L, Wei X, Yin J, Haley DR, Sun Q, Lundborg CS. Interventions to optimize the use of antibiotics in China: A scoping review of evidence from humans, animals, and the environment from a One Health perspective. One Health 2022; 14:100388. [PMID: 35686150 PMCID: PMC9171522 DOI: 10.1016/j.onehlt.2022.100388] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/02/2022] [Accepted: 04/03/2022] [Indexed: 12/28/2022] Open
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Coope C, Schneider A, Zhang T, Kadetz P, Feng R, Lambert H, Wang D, Oliver I, Michie S, Cabral C. Identifying key influences on antibiotic use in China: a systematic scoping review and narrative synthesis. BMJ Open 2022; 12:e056348. [PMID: 35338063 PMCID: PMC8961142 DOI: 10.1136/bmjopen-2021-056348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The inappropriate use of antibiotics is a key driver of antimicrobial resistance. In China, antibiotic prescribing and consumption exceed recommended levels and are relatively high internationally. Understanding the influences on antibiotic use is essential to informing effective evidence-based interventions. We conducted a scoping review to obtain an overview of empirical research about key behavioural, cultural, economic and social influences on antibiotic use in China. METHODS Searches were conducted in Econlit, Medline, PsycINFO, Social Science citation index and the Cochrane Database of Systematic Reviews for the period 2003 to early 2018. All study types were eligible including observational and intervention, qualitative and quantitative designs based in community and clinical settings. Two authors independently screened studies for inclusion. A data extraction form was developed incorporating details on study design, behaviour related to antibiotic use, influences on behaviour and information on effect (intervention studies only). RESULTS Intervention studies increased markedly from 2014, and largely focused on the impact of national policy and practice directives on antibiotic use in secondary and tertiary healthcare contexts in China. Most studies used pragmatic designs, such as before and after comparisons. Influences on antibiotic use clustered under four themes: antibiotic prescribing; adherence to antibiotics; self-medicating behaviour and over-the-counter sale of antibiotics. Many studies highlighted the use of antibiotics without a prescription for common infections, which was facilitated by availability of left-over medicines and procurement from local pharmacies. CONCLUSIONS Interventions aimed at modifying antibiotic prescribing behaviour show evidence of positive impact, but further research using more robust research designs, such as randomised trials, and incorporating process evaluations is required to better assess outcomes. The effect of national policy at the primary healthcare level needs to be evaluated and further exploration of the influences on antibiotic self-medicating is required to develop interventions that tackle this behaviour.
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Affiliation(s)
- Caroline Coope
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Annegret Schneider
- Population Health Sciences, University of Bristol, Bristol, UK
- Centre for Behaviour Change, University College London, London, UK
| | - Tingting Zhang
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Paul Kadetz
- Queen Margaret University, Institute for Global Health and Development, Edinburgh, UK
| | - Rui Feng
- Library, Anhui Medical University, Hefei, Anhui, China
| | - Helen Lambert
- Population Health Sciences, University of Bristol, Bristol, UK
| | - DeBin Wang
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Isabel Oliver
- Field Service, National Infection Service, Public Health England National Infection Service, Salisbury, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Christie Cabral
- Population Health Sciences, University of Bristol, Bristol, UK
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Bashingwa JJH, Shah N, Mohan D, Scott K, Chamberlain S, Mulder N, Rahul S, Arora S, Chakraborty A, Ummer O, Ved R, LeFevre AE. Examining the reach and exposure of a mobile phone-based training programme for frontline health workers (ASHAs) in 13 states across India. BMJ Glob Health 2021; 6:e005299. [PMID: 34429283 PMCID: PMC8386225 DOI: 10.1136/bmjgh-2021-005299] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022] Open
Abstract
Mobile phones are increasingly used to facilitate in-service training for frontline health workers (FLHWs). Mobile learning (mLearning) programmes have the potential to provide FLHWs with high quality, inexpensive, standardised learning at scale, and at the time and location of their choosing. However, further research is needed into FLHW engagement with mLearning content at scale, a factor which could influence knowledge and service delivery. Mobile Academy is an interactive voice response training course for FLHWs in India, which aims to improve interpersonal communication skills and refresh knowledge of preventative reproductive, maternal, neonatal and child health. FLHWs dial in to an audio course consisting of 11 chapters, each with a 4-question true/false quiz, resulting in a cumulative pass/fail score. In this paper, we analyse call data records from the national version of Mobile Academy to explore coverage, user engagement and completion. Over 158 596 Accredited Social Health Activists (ASHAs) initiated the national version, while 111 994 initiated the course on state-based platforms. Together, this represents 41% of the estimated total number of ASHAs registered in the government database across 13 states. Of those who initiated the national version, 81% completed it; and of those, over 99% passed. The initiation and completion rates varied by state, with Rajasthan having the highest initiation rate. Many ASHAs made multiple calls in the afternoons and evenings but called in for longer durations earlier in the day. Findings from this analysis provide important insights into the differential reach and uptake of the programme across states.
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Affiliation(s)
- Jean Juste Harrisson Bashingwa
- Computational Biology Division, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, Cape Town, Western Cape, South Africa
| | - Neha Shah
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Nicola Mulder
- Computational Biology Division, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, Cape Town, South Africa
| | - Sai Rahul
- BeeHyv Software Solutions Pvt. Ltd, Hyderabad, Telangana, India
| | - Salil Arora
- BBC Media Action, India, New Delhi, Delhi, India
| | | | - Osama Ummer
- BBC Media Action, India, New Delhi, Delhi, India
- Oxford Policy Management, New Delhi, Delhi, India
| | - Rajani Ved
- National Health Systems Resource Centre, New Delhi, Delhi, India
| | - Amnesty Elizabeth LeFevre
- International Health, Baltimore, Maryland, USA
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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12
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Lam TT, Dang DA, Tran HH, Do DV, Le H, Negin J, Jan S, Marks GB, Nguyen TA, Fox GJ, Beardsley J. What are the most effective community-based antimicrobial stewardship interventions in low- and middle-income countries? A narrative review. J Antimicrob Chemother 2021; 76:1117-1129. [PMID: 33491090 DOI: 10.1093/jac/dkaa556] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Antimicrobial resistance (AMR) is a major global issue and antimicrobial stewardship is central to tackling its emergence. The burden of AMR disproportionately impacts low- and middle-income countries (LMICs), where capacity for surveillance and management of resistant pathogens is least developed. Poorly regulated antibiotic consumption in the community is a major driver of AMR, especially in LMICs, yet community-based interventions are neglected in stewardship research, which is often undertaken in high-income settings and/or in hospitals. We reviewed the evidence available to researchers and policymakers testing or implementing community-based antimicrobial stewardship strategies in LMICs. We critically appraise that evidence, deliver recommendations and identify outstanding areas of research need. We find that multifaceted, education-focused interventions are likely most effective in our setting. We also confirm that the quality and quantity of community-based stewardship intervention research is limited, with research on microbiological, clinical and economic sustainability most urgently needed.
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Affiliation(s)
- Thanh Tuan Lam
- The Woolcock Institute of Medical Research, Kim Ma, Ha Noi, Vietnam
| | - Duc Anh Dang
- National Institute of Hygiene and Epidemiology, Hai Ba Trung, Hanoi, Vietnam
| | - Huy Hoang Tran
- National Institute of Hygiene and Epidemiology, Hai Ba Trung, Hanoi, Vietnam
| | - Dung Van Do
- The University of Medicine and Pharmacy, Hong Bang, Q5, Ho Chi Minh City, Vietnam
| | - Hien Le
- The Woolcock Institute of Medical Research, Kim Ma, Ha Noi, Vietnam
| | - Joel Negin
- The Sydney School of Public Health, University of Sydney, NSW 2006, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, NSW 2042, Australia
| | - Guy B Marks
- The University of New South Wales, Sydney, NSW 2052, Australia
| | - Thu Anh Nguyen
- The Woolcock Institute of Medical Research, Kim Ma, Ha Noi, Vietnam.,The Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Greg J Fox
- The Woolcock Institute of Medical Research, Kim Ma, Ha Noi, Vietnam.,The Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Justin Beardsley
- The Marie Bashir Institute, Westmead Institute for Medical Research, The University of Sydney, NSW 2145, Australia.,Oxford University Clinical Research Unit, Vo Van Kiet, Q5, Ho Chi Minh City, Vietnam
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13
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Nabovati E, Jeddi FR, Farrahi R, Anvari S. Information technology interventions to improve antibiotic prescribing for patients with acute respiratory infection: a systematic review. Clin Microbiol Infect 2021; 27:838-845. [PMID: 33813115 DOI: 10.1016/j.cmi.2021.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/19/2021] [Accepted: 03/14/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Information technology (IT) interventions provide physicians with easy and quick access to information at the point of care and can play a major role in clinical decision-making for antibiotic prescribing. This study aimed to examine the effects and characteristics of IT interventions on improving antibiotic prescribing for patients with acute respiratory infection (ARI). METHODS A comprehensive search was performed in Medline (through PubMed), ISI web of science, Embase, and Cochrane databases from inception to 31 August 2020. Randomized controlled trial (RCT) and cluster RCT (CRCT) studies examining the effectiveness of IT interventions in improving antibiotic prescribing for patients with ARI were included. Participants were patients with ARI. IT interventions were used for improving antibiotic prescribing. Two researchers independently extracted data from studies on methods, characteristics of interventions, and results. The characteristics of interventions were extracted based on three dimensions of IT design, data entry source, and implementation characteristics. RESULTS Eighteen studies (15 CRCTs and three RCTs) were included. Most of included studies (n = 11) were conducted in the United States. In 12 studies (66.7%), IT interventions improved the level of antibiotic prescribing, and in eight of the 12 studies the effect was statistically significant. In two studies the intervention had a statistically significant negative effect, and in two studies the level of antibiotic prescribing was not changed. Seventeen studies (94.4%) used clinical decision support systems (CDSSs) for the intervention. In 12 studies (66.7%) CDSSs were integrated with electronic health records (EHRs). CONCLUSIONS Information technology interventions have the potential to improve prescription of antibiotics for patients with acute respiratory infection and to change physicians' behaviours in this regard. Factors affecting the acceptance of IT-based interventions to improve prescription of antibiotics should be investigated in future studies.
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Affiliation(s)
- Ehsan Nabovati
- Health Information Management Research Centre, Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran.
| | - Fatemeh Rangraz Jeddi
- Health Information Management Research Centre, Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran
| | - Razieh Farrahi
- Student Research Committee, Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran.
| | - Shima Anvari
- Student Research Committee, Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran
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14
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Mwananyanda L, Pierre C, Mwansa J, Cowden C, Localio AR, Kapasa ML, Machona S, Musyani CL, Chilufya MM, Munanjala G, Lyondo A, Bates MA, Coffin SE, Hamer DH. Preventing Bloodstream Infections and Death in Zambian Neonates: Impact of a Low-cost Infection Control Bundle. Clin Infect Dis 2020; 69:1360-1367. [PMID: 30596901 DOI: 10.1093/cid/ciy1114] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/24/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sepsis is a leading cause of neonatal mortality in low-resource settings. As facility-based births become more common, the proportion of neonatal deaths due to hospital-onset sepsis has increased. METHODS We conducted a prospective cohort study in a neonatal intensive care unit in Zambia where we implemented a multifaceted infection prevention and control (IPC) bundle consisting of IPC training, text message reminders, alcohol hand rub, enhanced environmental cleaning, and weekly bathing of babies ≥1.5 kg with 2% chlorhexidine gluconate. Hospital-associated sepsis, bloodstream infection (BSI), and mortality (>3 days after admission) outcome data were collected for 6 months prior to and 11 months after bundle implementation. RESULTS Most enrolled neonates had a birth weight ≥1.5 kg (2131/2669 [79.8%]). Hospital-associated mortality was lower during the intervention than baseline period (18.0% vs 23.6%, respectively). Total mortality was lower in the intervention than prior periods. Half of enrolled neonates (50.4%) had suspected sepsis; 40.8% of cultures were positive. Most positive blood cultures yielded a pathogen (409/549 [74.5%]), predominantly Klebsiella pneumoniae (289/409 [70.1%]). The monthly rate and incidence density rate of suspected sepsis were lower in the intervention period for all birth weight categories, except babies weighing <1.0 kg. The rate of BSI with pathogen was also lower in the intervention than baseline period. CONCLUSIONS A simple IPC bundle can reduce sepsis and death in neonates hospitalized in high-risk, low-resource settings. Further research is needed to validate these findings in similar settings and to identify optimal implementation strategies for improvement and sustainability. CLINICAL TRIALS REGISTRATION NCT02386592.
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Affiliation(s)
- Lawrence Mwananyanda
- Right to Care, Lusaka, Zambia.,Department of Global Health, Boston University School of Public Health
| | - Cassandra Pierre
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Massachusetts
| | - James Mwansa
- Department of Pathology and Microbiology, University Teaching Hospital.,Lusaka Apex Medical University, Zambia
| | - Carter Cowden
- Division of Infectious Diseases, Children's Hospital of Philadelphia
| | - A Russell Localio
- Division of Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Monica L Kapasa
- Neonatal Intensive Care Unit, University Teaching Hospital, Lusaka, Zambia
| | - Sylvia Machona
- Neonatal Intensive Care Unit, University Teaching Hospital, Lusaka, Zambia
| | | | | | | | - Angela Lyondo
- Department of Pathology and Microbiology, University Teaching Hospital
| | - Matthew A Bates
- School of Life Sciences, University of Lincoln, United Kingdom
| | - Susan E Coffin
- Division of Infectious Diseases, Children's Hospital of Philadelphia
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health.,Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Massachusetts
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15
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Guo LP, Li ZH, Chen TL, Liu GH, Fan HY, Yang KH. The prevalence of mental distress and association with social changes among postgraduate students in China: a cross-temporal meta-analysis. Public Health 2020; 186:178-184. [PMID: 32853995 DOI: 10.1016/j.puhe.2020.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/21/2020] [Accepted: 06/07/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study aims to estimate the mental distress prevalence of Chinese postgraduate students and the association with the social changes based on the data between 2000 and 2019. STUDY DESIGN This is a cross-temporal meta-analysis study. METHODS The literature was retrieved with both English and Chinese electronic databases, including articles published from 2002 to 2019. Statistical analyses were performed with R 3.6.1 and SPSS 22. RESULTS Eighty-nine primary studies with 99 reports were included in our meta-analysis, totaling 54,722 Chinese postgraduate students. The result showed that: (a) the prevalence of mental distress was 28% (95% confidence interval [CI]: 25%-31%), and the prevalence of moderately positive symptoms was 9% (95% CI: 7%-11%); (b) the prevalence of positive symptoms was negatively correlated with the years of data collection and the prevalence of mental distress decreased by at least 16% from 2000 to 2019; and (c) social changes, particularly the policies of mental health and the educational environment had a significant contribution to these changes. CONCLUSIONS More than a quarter of postgraduate students have mental illness in China, whereas the prevalence of their mental distress has been decreasing. Social changes are shown to play an important role in contributing to this change.
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Affiliation(s)
- Liping P Guo
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China; Evidence-Based Social Sciences Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Zhihong H Li
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China; Evidence-Based Social Sciences Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Taolin L Chen
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Guanghua H Liu
- Evidence-Based Social Sciences Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China; School of Law, Lanzhou University, Lanzhou, Gansu, China
| | - Huiyong Y Fan
- School of Education, Bohai University, Jinzhou, Liaoning, China.
| | - Kehu H Yang
- Evidence-Based Social Sciences Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China; Evidence-Based Medicine Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China.
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16
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Jiang WJ, Yan PJ, Zhao CL, Si MB, Tian W, Zhang YJ, Tian HW, Feng SW, Han CW, Yang J, Yang KH, Guo TK. Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. Surg Endosc 2020; 34:1891-1903. [PMID: 32144555 DOI: 10.1007/s00464-019-07283-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/28/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the fact that thyroid surgery has evolved towards minimal incisions and endoscopic approaches, the role of total endoscopic thyroidectomy (TET) in thyroid cancer has been highly disputed. We performed a systematic review and meta-analyses of peer reviewed studies in order to evaluate the safety and effectiveness of TET compared with conventional open thyroidectomy (COT) in papillary thyroid cancer (PTC). METHOD Medical literature databases such as PubMed, Embase, the Cochrane Library, and Web of science were systematically searched for articles that compared TET and COT in PTC treatment from database inception until March 2019. The quality of the studies included in the review was evaluated using the Downs and Black scale using Review Manager software Stata V.13.0 for the meta-analysis. RESULTS The systematic review and meta-analysis were based on 5664 cases selected from twenty publications. Criteria used to determine surgical completeness included postoperative thyroglobulin (TG) levels, recurrence of the tumor after long-term follow-up. Adverse event and complication rate scores included transient recurrent laryngeal nerve (RLN) palsy, permanent RLN palsy, transient hypocalcaemia, permanent hypocalcaemia, operative time, number of removed lymph nodes, length of hospital stay and patient cosmetic satisfaction. TET was found to be generally equivalent to COT in terms of surgical completeness and adverse event rate, although TET resulted in lower levels of transient hypocalcemia (OR 1.66; p < 0.05), a smaller number of the retrieved lymph nodes (WMD 0.46; p < 0.05), and better cosmetic satisfaction (WMD 1.73; p < 0.05). COT was associated with a shorter operation time (WMD - 50.28; p < 0.05) and lower rates of transient RLN palsy (OR 0.41; p < 0.05). CONCLUSIONS The results show that in terms of safety and efficacy, TET was similar to COT for the treatment of thyroid cancer. Indeed, the tumor recurrence rates and the level of surgical completeness in TET are similar to those obtained for COT. TET was associated with significantly lower levels of transient hypocalcemia and better cosmetic satisfaction, and thus is the better option for patients with cosmetic concerns. Overall, randomized clinical trials and studies with larger patient cohorts and long-term follow-up data are required to further demonstrate the value of the TET.
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Affiliation(s)
- Wen-Jie Jiang
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People's Republic of China
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China
- Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, Gansu, People's Republic of China
| | - Pei-Jing Yan
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China
| | - Chun-Lin Zhao
- Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, Gansu, People's Republic of China
| | - Mou-Bo Si
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People's Republic of China
- Department of General Surgery, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, People's Republic of China
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China
| | - Wen Tian
- Department of General Surgery, First Clinical Center, PLA General Hospital, Beijing, 100000, People's Republic of China
| | - Yan-Jun Zhang
- Department of General Surgery, First Clinical Center, PLA General Hospital, Beijing, 100000, People's Republic of China
| | - Hong-Wei Tian
- Department of General Surgery, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, People's Republic of China
| | - Shuang-Wu Feng
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Cai-Wen Han
- Department of General Surgery, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, People's Republic of China
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China
| | - Jia Yang
- Department of General Surgery, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, People's Republic of China
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China
| | - Ke-Hu Yang
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People's Republic of China.
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China.
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China.
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, Gansu, People's Republic of China.
| | - Tian-Kang Guo
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People's Republic of China.
- Department of General Surgery, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, People's Republic of China.
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China.
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Laali E, Ghorbani A, Najafi S, Sarayani A, Ghafari S, Makarem J, Khorasani G, Gholami K, Jahangard‐Rafsanjani Z. Evaluation of pharmacist‐based interventions to optimise utilisation of parenteral paracetamol in a teaching hospital in Iran. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elahe Laali
- Department of Pharmacotherapy College of Pharmacy Tehran University of Medical Sciences Tehran Iran
| | - Azim Ghorbani
- Pharmaceutical Care Department College of Pharmacy Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Sheyda Najafi
- Pharmaceutical Care Department College of Pharmacy Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Amir Sarayani
- Research Center for Rational Use of Drugs Tehran University of Medical Sciences Tehran Iran
| | - Somayeh Ghafari
- Department of Pharmacotherapy College of Pharmacy Tehran University of Medical Sciences Tehran Iran
| | - Jalil Makarem
- Department of Anesthesiology Faculty of Medicine Imam Khomeini Hospital Complex Tehran University of Medical Sciences TehranIran
| | - Ghasemali Khorasani
- Plastic and Reconstructive Surgery Division Faculty of Medicine Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Kheirollah Gholami
- Research Center for Rational Use of Drugs Tehran University of Medical Sciences Tehran Iran
| | - Zahra Jahangard‐Rafsanjani
- Department of Pharmacotherapy College of Pharmacy Tehran University of Medical Sciences Tehran Iran
- Pharmaceutical Care Department College of Pharmacy Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
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18
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Kyaw BM, Tudor Car L, van Galen LS, van Agtmael MA, Costelloe CE, Ajuebor O, Campbell J, Car J. Health Professions Digital Education on Antibiotic Management: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res 2019; 21:e14984. [PMID: 31516125 PMCID: PMC6746065 DOI: 10.2196/14984] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/07/2019] [Accepted: 08/17/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Inappropriate antibiotic prescription is one of the key contributors to antibiotic resistance, which is managed with a range of interventions including education. OBJECTIVE We aimed to summarize evidence on the effectiveness of digital education of antibiotic management compared to traditional education for improving health care professionals' knowledge, skills, attitudes, and clinical practice. METHODS Seven electronic databases and two trial registries were searched for randomized controlled trials (RCTs) and cluster RCTs published between January 1, 1990, and September 20, 2018. There were no language restrictions. We also searched the International Clinical Trials Registry Platform Search Portal and metaRegister of Controlled Trials to identify unpublished trials and checked the reference lists of included studies and relevant systematic reviews for study eligibility. We followed Cochrane methods to select studies, extract data, and appraise and synthesize eligible studies. We used random-effect models for the pooled analysis and assessed statistical heterogeneity by visual inspection of a forest plot and calculation of the I2 statistic. RESULTS Six cluster RCTs and two RCTs with 655 primary care practices, 1392 primary care physicians, and 485,632 patients were included. The interventions included personal digital assistants; short text messages; online digital education including emails and websites; and online blended education, which used a combination of online digital education and traditional education materials. The control groups received traditional education. Six studies assessed postintervention change in clinical practice. The majority of the studies (4/6) reported greater reduction in antibiotic prescription or dispensing rate with digital education than with traditional education. Two studies showed significant differences in postintervention knowledge scores in favor of mobile education over traditional education (standardized mean difference=1.09, 95% CI 0.90-1.28; I2=0%; large effect size; 491 participants [2 studies]). The findings for health care professionals' attitudes and patient-related outcomes were mixed or inconclusive. Three studies found digital education to be more cost-effective than traditional education. None of the included studies reported on skills, satisfaction, or potential adverse effects. CONCLUSIONS Findings from studies deploying mobile or online modalities of digital education on antibiotic management were complementary and found to be more cost-effective than traditional education in improving clinical practice and postintervention knowledge, particularly in postregistration settings. There is a lack of evidence on the effectiveness of other digital education modalities such as virtual reality or serious games. Future studies should also include health care professionals working in settings other than primary care and low- and middle-income countries. CLINICAL TRIAL PROSPERO CRD42018109742; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=109742.
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Affiliation(s)
- Bhone Myint Kyaw
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Louise Sandra van Galen
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Research & Expertise Center In Pharmacotherapy Education, Amsterdam, Netherlands
| | - Céire E Costelloe
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Onyema Ajuebor
- Health Workforce Department, World Health Organization, Geneva, Switzerland
| | - James Campbell
- Health Workforce Department, World Health Organization, Geneva, Switzerland
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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19
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Dunleavy G, Nikolaou CK, Nifakos S, Atun R, Law GCY, Tudor Car L. Mobile Digital Education for Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res 2019; 21:e12937. [PMID: 30747711 PMCID: PMC6390189 DOI: 10.2196/12937] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 02/06/2023] Open
Abstract
Background There is a pressing need to implement efficient and cost-effective training to address the worldwide shortage of health professionals. Mobile digital education (mLearning) has been mooted as a potential solution to increase the delivery of health professions education as it offers the opportunity for wide access at low cost and flexibility with the portability of mobile devices. To better inform policy making, we need to determine the effectiveness of mLearning. Objective The primary objective of this review was to evaluate the effectiveness of mLearning interventions for delivering health professions education in terms of learners’ knowledge, skills, attitudes, and satisfaction. Methods We performed a systematic review of the effectiveness of mLearning in health professions education using standard Cochrane methodology. We searched 7 major bibliographic databases from January 1990 to August 2017 and included randomized controlled trials (RCTs) or cluster RCTs. Results A total of 29 studies, including 3175 learners, met the inclusion criteria. A total of 25 studies were RCTs and 4 were cluster RCTs. Interventions comprised tablet or smartphone apps, personal digital assistants, basic mobile phones, iPods, and Moving Picture Experts Group-1 audio layer 3 player devices to deliver learning content. A total of 20 studies assessed knowledge (n=2469) and compared mLearning or blended learning to traditional learning or another form of digital education. The pooled estimate of studies favored mLearning over traditional learning for knowledge (standardized mean difference [SMD]=0.43, 95% CI 0.05-0.80, N=11 studies, low-quality evidence). There was no difference between blended learning and traditional learning for knowledge (SMD=0.20, 95% CI –0.47 to 0.86, N=6 studies, low-quality evidence). A total of 14 studies assessed skills (n=1097) and compared mLearning or blended learning to traditional learning or another form of digital education. The pooled estimate of studies favored mLearning (SMD=1.12, 95% CI 0.56-1.69, N=5 studies, moderate quality evidence) and blended learning (SMD=1.06, 95% CI 0.09-2.03, N=7 studies, low-quality evidence) over traditional learning for skills. A total of 5 and 4 studies assessed attitudes (n=440) and satisfaction (n=327), respectively, with inconclusive findings reported for each outcome. The risk of bias was judged as high in 16 studies. Conclusions The evidence base suggests that mLearning is as effective as traditional learning or possibly more so. Although acknowledging the heterogeneity among the studies, this synthesis provides encouraging early evidence to strengthen efforts aimed at expanding health professions education using mobile devices in order to help tackle the global shortage of health professionals.
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Affiliation(s)
- Gerard Dunleavy
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | | | - Sokratis Nifakos
- Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden
| | - Rifat Atun
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States
| | - Gloria Chun Yi Law
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Steinhardt LC, Mathanga DP, Mwandama D, Nsona H, Moyo D, Gumbo A, Kobayashi M, Namuyinga R, Shah MP, Bauleni A, Troell P, Zurovac D, Rowe AK. The Effect of Text Message Reminders to Health Workers on Quality of Care for Malaria, Pneumonia, and Diarrhea in Malawi: A Cluster-Randomized, Controlled Trial. Am J Trop Med Hyg 2019; 100:460-469. [PMID: 30628566 DOI: 10.4269/ajtmh.18-0529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The use of mobile technologies in medicine, or mHealth, holds promise to improve health worker (HW) performance, but evidence is mixed. We conducted a cluster-randomized controlled trial to evaluate the effect of text message reminders to HWs in outpatient health facilities (HFs) on quality of care for malaria, pneumonia, and diarrhea in Malawi. After a baseline HF survey (2,360 patients) in January 2015, 105 HFs were randomized to three arms: 1) text messages to HWs on malaria case management; 2) text messages to HWs on malaria, pneumonia, and diarrhea case management (latter two for children < 5 years); and 3) control arm (no messages). Messages were sent beginning April 2015 twice daily for 6 months, followed by an endline HF survey (2,536 patients) in November 2015. An intention-to-treat analysis with difference-in-differences binomial regression modeling was performed. The proportion of patients with uncomplicated malaria managed correctly increased from 42.8% to 59.6% in the control arm, from 43.7% to 55.8% in arm 1 (effect size -4.7%-points, 95% confidence interval (CI): -18.2, 8.9, P = 0.50) and from 30.2% to 50.9% in arm 2 (effect size 3.9%-points, 95% CI: -14.1, 22.0, P = 0.67). Prescription of first-line antibiotics to children < 5 years with clinically defined pneumonia increased in all arms, but decreased in arm 2 (effect size -4.1%-points, 95% CI: -42.0, 33.8, P = 0.83). Prescription of oral rehydration solution to children with diarrhea declined slightly in all arms. We found no significant improvements in malaria, pneumonia, or diarrhea treatment after HW reminders, illustrating the importance of rigorously testing new interventions before adoption.
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Affiliation(s)
- Laura C Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Don P Mathanga
- Malaria Alert Centre, College of Medicine, Blantyre, Malawi
| | - Dyson Mwandama
- Malaria Alert Centre, College of Medicine, Blantyre, Malawi
| | | | | | | | - Miwako Kobayashi
- Respiratory Diseases Branch, Division of Bacterial Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth Namuyinga
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Monica P Shah
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andy Bauleni
- Malaria Alert Centre, College of Medicine, Blantyre, Malawi
| | - Peter Troell
- US President's Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Dejan Zurovac
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Alexander K Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia
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Bonawitz R, Bird L, Le NB, Nguyen VH, Halim N, Williams AL, Sabin L, Gill CJ. Implementing the mobile continuing medical education (mCME) project in Vietnam: making it work and sharing lessons learned. Mhealth 2019; 5:7. [PMID: 30976599 PMCID: PMC6414330 DOI: 10.21037/mhealth.2019.02.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 01/31/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Mobile technology is a novel approach for delivering continuing medical education (CME), with numerous advantages including lower costs and the ability to reach larger numbers than traditional in-person CME workshops. METHODS From May 2015 to May 2017, we conducted two randomized controlled trials in a phased approach to evaluate the effectiveness of a mobile CME (mCME) approach for two cadres of health professionals in Vietnam. The first randomized controlled trial (RCT) tested the use of an SMS-based educational intervention among Community-Based Physician's Assistants; while feasible and acceptable, this intervention failed to improve medical knowledge among participants. Given the failure of the first RCT, and drawing on qualitative work conducted with participants at the conclusion of the trial, various modifications were employed in the second RCT conducted among HIV specialist physicians in Vietnam. Version 2.0 of the mCME intervention did lead to significant improvement in medical knowledge among intervention participants. Here, we discuss in detail the development of an mCME platform and the experiential "lessons learned" during two phases of implementation. RESULTS Numerous lessons were learned during implementation, including the importance of: (I) mixed methods approaches; (II) an underlying theoretical framework for behavior change projects; (III) expertise in software programming; (IV) aligning educational content to a well-defined participant population; and (V) engaging and motivating adult learners. We also discuss the critical importance of projects with local ownership and investment that are relevant to local problems. CONCLUSIONS mHealth approaches for continued healthcare training and education is increasingly relevant in many low-resource settings, the lessons learned here will be valuable to other organizations looking to scale-up similar mHealth-type educational programmes.
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Affiliation(s)
- Rachael Bonawitz
- Department of Global Health, Boston University School of Public Health, Boston, USA
- Department of Pediatrics, Boston University School of Medicine, Boston, USA
| | - Liat Bird
- Department of Pediatrics, University of California, San Francisco, USA
| | - Ngoc Bao Le
- Consulting, Researching on Community Development (CRCD), Hanoi, Vietnam
| | - Viet Ha Nguyen
- Consulting, Researching on Community Development (CRCD), Hanoi, Vietnam
| | - Nafisa Halim
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | - Anna Larson Williams
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | - Lora Sabin
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | - Christopher J. Gill
- Department of Global Health, Boston University School of Public Health, Boston, USA
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Brownsworth C, Kaniecki T, Broom M. text4peds: a randomised text-messaging trial. CLINICAL TEACHER 2018; 16:485-489. [PMID: 30345658 DOI: 10.1111/tct.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The use of cell phone text messaging in the medical field is of growing interest, but there are few data examining its value in medical education. The text4peds educational text-messaging program was created for third-year medical students preparing for the National Board of Medical Examiners (NBME) paediatric subject examination. METHODS A randomised, controlled trial was conducted with third-year medical students on their paediatric clerkship. Students in the intervention group received daily messages consisting of multiple-choice questions with links to online material. The control group received no text messages. The impact of the intervention was assessed by examining the participants' NBME examination scores and by participant surveys. RESULTS A total of 162 students participated in the study. There was no statistical difference between the two groups, with the texting group having a mean score of 77.7 and with the non-texting group having a mean score of 77.8 on the NBME. Subgroup analysis examining the effect of anticipated specialty and online material interaction also failed to find any statistically significant difference. Students reported satisfaction with the program, with 84% rating the text messages as helpful. The students rated their participation as high, with 92% saying that they looked at the messages more than 60% of the time. Among those who received text messages, 90% would recommend the program to others. There was no statistical difference between the two group CONCLUSION: A text-messaging-based educational tool had a perceived positive educational value for medical students. This study failed to show any statistically significant impact on NBME examination scores from the text-messaging intervention.
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Affiliation(s)
| | - Timothy Kaniecki
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Matthew Broom
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
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23
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Rassi C, Gore-Langton GR, Gidudu Walimbwa B, Strachan CE, King R, Basharat S, Christiansen-Jucht C, Graham K, Gudoi SS. Improving health worker performance through text messaging: A mixed-methods evaluation of a pilot intervention designed to increase coverage of intermittent preventive treatment of malaria in pregnancy in West Nile, Uganda. PLoS One 2018; 13:e0203554. [PMID: 30188956 PMCID: PMC6126848 DOI: 10.1371/journal.pone.0203554] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 08/22/2018] [Indexed: 12/20/2022] Open
Abstract
Poor health worker performance is a well-documented obstacle to quality service provision. Due to the increasingly widespread availability of mobile devices, mobile health (mHealth) has received growing attention as a service improvement tool. This pilot study explored feasibility, acceptability and outcomes of an mHealth intervention designed to increase coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) in two districts of West Nile, Uganda. In both districts, selected health workers (N = 48) received classroom training on malaria in pregnancy. All health workers in one district (N = 49) subsequently received 24 text messages reinforcing the training content. The intervention was evaluated using a mixed-methods approach, including four focus group discussions with health workers and three in-depth interviews with district health officials, health worker knowledge assessments one month (N = 90) and six months (N = 89) after the classroom training, and calculation of IPTp coverage from participating health facilities’ (N = 16) antenatal care registers covering six months pre- and post-intervention. Complementing classroom training with text messaging was found to be a feasible, acceptable and inexpensive approach to improving health worker performance. The messages served as reminders to those who had attended the classroom training and helped spread information to those who had not. Health workers in the district where text messages were sent had significantly better knowledge of IPTp, achieving an increased composite knowledge score of 6.00 points (maximum score: 40) compared with those in the district where only classroom training was provided. Average facility coverage of three doses of IPTp was also significantly higher where text messages were sent (85.8%) compared with the district where only classroom training was provided (54.1%). This intervention shows promise for the improvement of health worker performance for delivery of IPTp, and could have significant broader application.
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Affiliation(s)
| | | | | | - Clare E. Strachan
- Malaria Consortium, London, United Kingdom
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Cambridge Economic Policy Associates, London, United Kingdom
| | - Rebecca King
- The Nuffield Centre for International Health & Development, University of Leeds, Leeds, United Kingdom
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24
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Perceptions and Acceptability of Receiving SMS Self-care Messages in Chinese Patients With Heart Failure: An Inpatient Survey. J Cardiovasc Nurs 2018; 32:357-364. [PMID: 27617565 DOI: 10.1097/jcn.0000000000000349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Self-care is critical for postdischarge heart failure (HF) patients. Short message service (SMS) is a promising way to promote HF self-care. OBJECTIVE The aim of this study is to investigate knowledge status in Chinese HF patients, as well as the acceptance of SMS as a way to improve self-care. METHODS A survey using a self-developed questionnaire was conducted in patients with decompensated HF 2 days before discharge. RESULTS A total of 540 patients completed the survey. Among them, only 69.8% and 63.3% of patients were aware of their HF status and medication regimen, respectively. A total of 95.6% patients were willing to receive SMS. Patient himself/herself, caregiver, or both patient and caregiver were almost equally selected as the preferred receiver of SMS. Educational and/or reminder SMS was considered "very helpful" by 50.2% of the patients as a way of promoting self-care, similar to that of telephone education and brochure education. "Take your medicine", "avoid getting flu," and "keep follow-up" were regarded as the most important self-care contents, whereas "weigh yourself every day" and "restrict fluid intake" were considered the least important. CONCLUSION As a way of promoting HF self-care, SMS intervention combining educational and reminder function might be well accepted by HF patients in China. The status of HF, medication, weight control, and fluid restriction should be emphasized during the practice. Caution should be drawn as the survey was not tested elsewhere. Further clinical trials would be conducted to examine the effect of SMS intervention on self-care behaviors and outcomes of HF patients.
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25
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Gill CJ, Le NB, Halim N, Chi CTH, Nguyen VH, Bonawitz R, Hoang PV, Nguyen HL, Huong PTT, Larson Williams A, Le NA, Sabin L. mCME project V.2.0: randomised controlled trial of a revised SMS-based continuing medical education intervention among HIV clinicians in Vietnam. BMJ Glob Health 2018; 3:e000632. [PMID: 29527350 PMCID: PMC5841494 DOI: 10.1136/bmjgh-2017-000632] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/17/2018] [Accepted: 01/20/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Continuing medical education (CME) is indispensable, but costs are a barrier. We tested the effectiveness of a novel mHealth intervention (mCME V.2.0) promoting CME among Vietnamese HIV clinicians. METHODS We enrolled HIV clinicians from three provinces near Hanoi. The 6-month intervention consisted of (1) daily short message service multiple-choice quiz questions, (2) daily linked readings, (3) links to online CME courses and (4) feedback messages describing the performance of the participant relative to the group. Control participants had equal access to the online CME courses. Our primary endpoint was utilisation of the online CME courses; secondary endpoints were self-study behaviour, performance on a standardised medical exam and job satisfaction. RESULTS From 121 total HIV clinicians in the three provinces, 106 (87.6%) enrolled, and 48/53 intervention (90%) and 47/53 control (89%) participants completed the endline evaluations. Compared with controls, intervention participants were more likely to use the CME courses (risk ratio (RR) 2.3, 95% CI 1.4 to 3.8, accounting for 83% of course use (P<0.001)). Intervention participants increased self-study behaviours over controls in terms of use of medical textbooks (P<0.01), consulting with colleagues (P<0.01), searching on the internet (P<0.001), using specialist websites (P=0.02), consulting the Vietnam HIV/AIDS treatment guidelines (P=0.02) and searching the scientific literature (P=0.09). Intervention participants outperformed controls on the exam (+23% vs +12% score gains, P=0.05) and had higher job satisfaction. CONCLUSION The mCME V.2.0 intervention improved self-study behaviour, medical knowledge and job satisfaction. This approach has potential for expansion in Vietnam and similar settings. TRIAL REGISTRATION NUMBER NCT02381743.
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Affiliation(s)
- Christopher J Gill
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ngoc Bao Le
- Consulting Research for Community Development, Hanoi, Vietnam
| | - Nafisa Halim
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Cao Thi Hue Chi
- Vietnam Authority for AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Viet Ha Nguyen
- Center for Population Research Information and Databases (CPRID), General Office for Population and Family Planning, Ministry of Health, Hanoi, Vietnam
| | - Rachael Bonawitz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Pham Vu Hoang
- Center for Population Research Information and Databases (CPRID), General Office for Population and Family Planning, Ministry of Health, Hanoi, Vietnam
| | - Hoang Long Nguyen
- Vietnam Authority for AIDS Control, Ministry of Health, Hanoi, Vietnam
| | | | - Anna Larson Williams
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Lora Sabin
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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26
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Hong YA, Zhou Z, Fang Y, Shi L. The Digital Divide and Health Disparities in China: Evidence From a National Survey and Policy Implications. J Med Internet Res 2017; 19:e317. [PMID: 28893724 PMCID: PMC5613190 DOI: 10.2196/jmir.7786] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/12/2017] [Accepted: 07/12/2017] [Indexed: 01/23/2023] Open
Abstract
Background The digital divide persists despite broad accessibility of mobile tools. The relationship between the digital divide and health disparities reflects social status in terms of access to resources and health outcomes; however, data on this relationship are limited from developing countries such as China. Objective The aim of this study was to examine the current rates of access to mobile tools (Internet use and mobile phone ownership) among older Chinese individuals (aged ≥45 years), the predictors of access at individual and community levels, and the relationship between access to mobile tools and health outcomes. Methods We drew cross-sectional data from a national representative survey, the China Health and Retirement Longitudinal Study (CHARLS), which focused on the older population (aged ≥45 years). We used two-level mixed logistic regression models, controlling for unobserved heterogeneity at the community and individual levels for data analysis. In addition to individual-level socioeconomic status (SES), we included community-level resources such as neighborhood amenities, health care facilities, and community organizations. Health outcomes were measured by self-reported health and absence of disability based on validated scales. Results Among the 18,215 participants, 6.51% had used the Internet in the past month, and 83% owned a mobile phone. In the multivariate models, Internet use was strongly associated with SES, rural or urban residence, neighborhood amenities, community resources, and geographic region. Mobile phone ownership was strongly associated with SES and rural/urban residence but not so much with neighborhood amenities and community resources. Internet use was a significant predictor of self-reported health status, and mobile phone ownership was significantly associated with having disability even after controlling for potential confounders at the individual and community levels. Conclusions This study is one of the first to examine digital divide and its relationship with health disparities in China. The data showed a significant digital divide in China, especially in the older population. Internet access is still limited to people with higher SES; however, the mobile phone has been adopted by the general population. The digital divide is associated with not only individual SES but also community resources. Future electronic health (eHealth) programs need to consider the accessibility of mobile tools and develop culturally appropriate programs for various social groups.
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Affiliation(s)
- Y Alicia Hong
- School of Public Health, Xiamen University, Xiamen, China.,School of Public Health, Texas A&M University, College Station, TX, United States
| | - Zi Zhou
- School of Public Health, Xiamen University, Xiamen, China
| | - Ya Fang
- School of Public Health, Xiamen University, Xiamen, China
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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27
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Sabin LL, Larson Williams A, Le BN, Herman AR, Viet Nguyen H, Albanese RR, Xiong W, Shobiye HO, Halim N, Tran LTN, McNabb M, Hoang H, Falconer A, Nguyen TTT, Gill CJ. Benefits and Limitations of Text Messages to Stimulate Higher Learning Among Community Providers: Participants' Views of an mHealth Intervention to Support Continuing Medical Education in Vietnam. GLOBAL HEALTH: SCIENCE AND PRACTICE 2017; 5:261-273. [PMID: 28655802 PMCID: PMC5487088 DOI: 10.9745/ghsp-d-16-00348] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/21/2017] [Indexed: 11/18/2022]
Abstract
The original intention was to deliver technical content through brief text messages to stimulate participants to undertake deeper learning. While participants appreciated the convenience and relevance of the text messages, their scores of higher-order knowledge did not improve. The intervention may not have been successful because the messages lacked depth and interactivity, and participants were not explicitly encouraged to seek deeper learning. Background: A randomized controlled trial was conducted in 2015 to evaluate a mobile continuing medical education (mCME) intervention that provided daily text messages to community-based physicians' assistants (CBPAs) in Thai Nguyen Province, Vietnam. Although the intervention failed to improve medical knowledge over a 6-month period, a companion qualitative study provided insights on the views and experiences of intervention participants. Methods: We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) among participants randomized to receive text messages containing either simple medical facts or quiz questions. Trained interviewers collected data immediately following the conclusion of the trial in December 2015. Using semi-structured question guides, respondents were queried on their views of the intervention, positive and negative, and perceived impacts of the intervention. During analysis, after learning that the intervention had failed to increase knowledge among participants, we also examined reasons for lack of improvement in medical knowledge. All analyses were performed in NVivo using a thematic approach. Results: A total of 70 CBPAs engaged in one of 8 FGDs or an IDI. One-half were men; average age among all respondents was 40 years. Most (81%) practiced in rural settings and most (51%) focused on general medicine. The mean length of work experience was 3 years. All respondents made positive comments about the intervention; convenience, relevance, and quick feedback (quiz format) were praised. Downsides encompassed lack of depth of information, weak interaction, technology challenges, and challenging/irrelevant messages. Respondents described perceived impacts encompassing increased motivation, knowledge, collegial discussions, Internet use to search for more information, and clinical skills. Overall, they expressed a desire for the intervention to continue and recommended expansion to other medical professionals. Overreliance on the text messages, lack of effective self-study, and technical/language-based barriers may be potential explanations for intervention failure. Conclusion: As a form of mCME, daily text messages were well-received by community-level health care providers in Vietnam. This mCME approach appears very promising in low-resource environments or where traditional forms of CME are impractical. Future models might consider enhancements to foster linkages to relevant medical materials, improve interaction with medical experts, and tailor medical content to the daily activities of medical staff.
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Affiliation(s)
- Lora L Sabin
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA. .,Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Anna Larson Williams
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | - Bao Ngoc Le
- Pathfinder International in Vietnam, Hanoi, Vietnam
| | - Augusta R Herman
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | - Ha Viet Nguyen
- Center for Population Research Information and Databases (CPRID), Ministry of Health, Hanoi, Vietnam
| | - Rebecca R Albanese
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | - Wenjun Xiong
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | - Hezekiah Oa Shobiye
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | - Nafisa Halim
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.,Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Lien Thi Ngoc Tran
- Thái Nguyên Provincial Department of Public Health, Thái Nguyên Province, Vietnam
| | - Marion McNabb
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Pathfinder International, Watertown, MA, USA
| | - Hai Hoang
- Thái Nguyên Provincial Department of Public Health, Thái Nguyên Province, Vietnam
| | - Ariel Falconer
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | - Tam Thi Thanh Nguyen
- Center for Population Research Information and Databases (CPRID), Ministry of Health, Hanoi, Vietnam
| | - Christopher J Gill
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.,Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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28
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Adepoju IOO, Albersen BJA, De Brouwere V, van Roosmalen J, Zweekhorst M. mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review. JMIR Mhealth Uhealth 2017; 5:e38. [PMID: 28336504 PMCID: PMC5383806 DOI: 10.2196/mhealth.7185] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/17/2017] [Accepted: 02/21/2017] [Indexed: 02/07/2023] Open
Abstract
Background In a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for example, is established in resource-rich settings. However, the extent to which mobile clinical decision support systems (mCDSS) have been adopted specifically in resource-poor settings such as Africa and the lessons learned about their use in such settings are yet to be established. Objective The aim of this study was to synthesize evidence on the use of mHealth for point-of-care decision support and improved quality of care by health care workers in Africa. Methods A scoping review of 4 peer-reviewed and 1 grey literature databases was conducted. No date limits were applied, but only articles in English language were selected. Using pre-established criteria, 2 reviewers screened articles and extracted data. Articles were analyzed using Microsoft Excel and MAXQDA. Results We retained 22 articles representing 11 different studies in 7 sub-Saharan African countries. Interventions were mainly in the domain of maternal health and ranged from simple text messaging (short message service, SMS) to complex multicomponent interventions. Although health workers are generally supportive of mCDSS and perceive them as useful, concerns about increased workload and altered workflow hinder sustainability. Facilitators and barriers to use of mCDSS include technical and infrastructural support, ownership, health system challenges, and training. Conclusions The use of mCDSS in sub-Saharan Africa is an indication of progress in mHealth, although their effect on quality of service delivery is yet to be fully explored. Lessons learned are useful for informing future research, policy, and practice for technologically supported health care delivery, especially in resource-poor settings.
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Affiliation(s)
- Ibukun-Oluwa Omolade Adepoju
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Institute of Tropical Medicine, Maternal and Reproductive Health Unit, Department of Public Health, Antwerp, Belgium
| | - Bregje Joanna Antonia Albersen
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Vincent De Brouwere
- Institute of Tropical Medicine, Maternal and Reproductive Health Unit, Department of Public Health, Antwerp, Belgium
| | - Jos van Roosmalen
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Leiden University Medical Center, Department of Obstetrics, Leiden, Netherlands
| | - Marjolein Zweekhorst
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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29
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Tian M, Zhang J, Luo R, Chen S, Petrovic D, Redfern J, Xu DR, Patel A. mHealth Interventions for Health System Strengthening in China: A Systematic Review. JMIR Mhealth Uhealth 2017; 5:e32. [PMID: 28302597 PMCID: PMC5374274 DOI: 10.2196/mhealth.6889] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/26/2017] [Accepted: 02/10/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND With rapidly expanding infrastructure in China, mobile technology has been deemed to have the potential to revolutionize health care delivery. There is particular promise for mobile health (mHealth) to positively influence health system reform and confront the new challenges of chronic diseases. OBJECTIVE The aim of this study was to systematically review existing mHealth initiatives in China, characterize them, and examine the extent to which mHealth contributes toward the health system strengthening in China. Furthermore, we also aimed to identify gaps in mHealth development and evaluation. METHODS We systematically reviewed the literature from English and Chinese electronic database and trial registries, including PubMed, EMBASE, Cochrane, China National Knowledge of Infrastructure (CNKI), and World Health Organization (WHO) International Clinical Trials Registry Platform. We used the English keywords of mHealth, eHealth, telemedicine, telehealth, mobile phone, cell phone, text messaging, and China, as well as their corresponding Chinese keywords. All articles using mobile technology for health care management were included in the study. RESULTS A total of 1704 articles were found using the search terms, and eventually 72 were included. Overall, few high quality interventions were identified. Most interventions were found to be insufficient in scope, and their evaluation was of inadequate rigor to generate scalable solutions and provide reliable evidence of effectiveness. Most interventions focused on text messaging for consumer education and behavior change. There were a limited number of interventions that addressed health information management, health workforce issues, use of medicines and technologies, or leadership and governance from a health system perspective. CONCLUSIONS We provide four recommendations for future mHealth interventions in China that include the need for the development, evaluation and trials examining integrated mHealth interventions to guide the development of future mHealth interventions, target disadvantaged populations with mHealth interventions, and generate appropriate evidence for scalable and sustainable models of care.
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Affiliation(s)
- Maoyi Tian
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Sydney Medical School, The George Institute for Global Health, Australia, University of Sydney, Sydney, Australia
| | - Jing Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Rong Luo
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Shi Chen
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Djordje Petrovic
- Medical School, University of Michigan, Ann Arbor, MI, United States
| | - Julie Redfern
- Sydney Medical School, The George Institute for Global Health, Australia, University of Sydney, Sydney, Australia
| | - Dong Roman Xu
- Sun Yat-sen Global Health Institute, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Anushka Patel
- Sydney Medical School, The George Institute for Global Health, Australia, University of Sydney, Sydney, Australia
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Zhan XX, Zhang ZX, Sun F, Peng WJ, Zhang H, Yan WR. The attitudes of primary healthcare providers towards web-based training on public health services in rural China: a cross-sectional study. Public Health 2016; 141:153-162. [PMID: 27931992 DOI: 10.1016/j.puhe.2016.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 08/31/2016] [Accepted: 09/06/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To explore the attitudes of primary healthcare workers, including township public health workers (TPHWs) and village doctors (ViDs), towards web-based training on basic public health services (BPHS) and to examine the factors influencing their attitudes. STUDY DESIGN Cross-sectional study. METHODS Questionnaires addressing training status, needs, and attitudes towards web-based public health training were administered to 2768 primary healthcare workers from May to September 2013. Multivariate logistic regression models were used to identify the factors that were significantly associated with a positive attitude towards web-based public health training. RESULTS Among the 2768 participants, 90.6% of the TPHWs and 86.9% of the ViDs expressed a positive attitude towards web-based BPHS training. TPHWs who had a positive attitude towards previous public health training (odds ratio [OR] = 2.75, 95% confidence interval [CI] = 1.28-5.93) and better computer skills (OR = 2.59, 95% CI = 1.03-6.48) were more likely to adopt web-based training on BPHS, as were ViDs who had better computer skills (OR = 2.54, 95% CI = 1.58-4.11) and better Internet speeds (neutral: OR = 2.81, 95% CI = 1.58-5.01; satisfied: OR = 2.53, 95% CI = 1.28-5.01). TPHWs who tended to read papers (OR = 0.24, 95% CI = 0.11-0.50) and were aged 50 years or older (OR = 0.34, 95% CI = 0.14-0.87), as were ViDs who tended to read papers (OR = 0.48, 95% CI = 0.29-0.77), expressed a more negative attitude towards web-based BPHS training. CONCLUSIONS The findings indicated that most primary healthcare workers have a positive attitude towards web-based BPHS training. More priority measures, such as conducting computer training, improving Internet quality and integrating mobile technology, are recommended and will further improve the implementation of web-based public health training programs.
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Affiliation(s)
- X X Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, PR China
| | - Z X Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, PR China
| | - F Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, PR China
| | - W J Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, PR China
| | - H Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, PR China
| | - W R Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, PR China.
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Gill CJ, Le Ngoc B, Halim N, Nguyen Viet H, Larson Williams A, Nguyen Van T, McNabb M, Tran Thi Ngoc L, Falconer A, An Phan Ha H, Rohr J, Hoang H, Michiel J, Nguyen Thi Thanh T, Bird L, Pham Vu H, Yeshitla M, Ha Van N, Sabin L. The mCME Project: A Randomized Controlled Trial of an SMS-Based Continuing Medical Education Intervention for Improving Medical Knowledge among Vietnamese Community Based Physicians' Assistants. PLoS One 2016; 11:e0166293. [PMID: 27861516 PMCID: PMC5115715 DOI: 10.1371/journal.pone.0166293] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 10/24/2016] [Indexed: 11/29/2022] Open
Abstract
Background Community health workers (CHWs) provide critical services to underserved populations in low and middle-income countries, but maintaining CHW’s clinical knowledge through formal continuing medical education (CME) activities is challenging and rarely occurs. We tested whether a Short Message Service (SMS)-based mobile CME (mCME) intervention could improve medical knowledge among a cadre of Vietnamese CHWs (Community Based Physician’s Assistants–CBPAs) who are the leading providers of primary medical care for rural underserved populations. Methods The mCME Project was a three arm randomized controlled trial. Group 1 served as controls while Groups 2 and 3 experienced two models of the mCME intervention. Group 2 (passive model) participants received a daily SMS bullet point, and were required to reply to the text to acknowledge receipt; Group 3 (interactive model) participants received an SMS in multiple choice question format addressing the same thematic area as Group 2, entering an answer (A, B, C or D) in their response. The server provided feedback immediately informing the participant whether the answer was correct. Effectiveness was based on standardized examination scores measured at baseline and endline (six months later). Secondary outcomes included job satisfaction and self-efficacy. Results 638 CBPAs were enrolled, randomized, and tested at baseline, with 592 returning at endline (93.7%). Baseline scores were similar across all three groups. Over the next six months, participation of Groups 2 and 3 remained high; they responded to >75% of messages. Group 3 participants answered 43% of the daily SMS questions correctly, but their performance did not improve over time. At endline, the CBPAs reported high satisfaction with the mCME intervention, and deemed the SMS messages highly relevant. However, endline exam scores did not increase over baseline, and did not differ between the three groups. Job satisfaction and self-efficacy scores also did not improve. Average times spent on self-study per week did not increase, and the kinds of knowledge resources used by the CBPAs did not differ between the three groups; textbooks, while widely available, were seldom used. Conclusions The SMS-based mCME intervention, while feasible and acceptable, did not result in increased medical knowledge. We hypothesize that this was because the intervention failed to stimulate lateral learning. For an intervention of this kind to be effective, it will be essential to find more effective ways to couple SMS as a stimulus to promote increased self-study behaviors. Trial Registration ClinicalTrials.gov NCT02381743
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Affiliation(s)
- Christopher J. Gill
- Center for Global Health and Development, Boston University, Boston, MA, United States of America
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
- * E-mail:
| | - Bao Le Ngoc
- Pathfinder International in Vietnam, Hanoi, Vietnam
| | - Nafisa Halim
- Center for Global Health and Development, Boston University, Boston, MA, United States of America
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Ha Nguyen Viet
- Center for Population Research Information and Databases (CPRID), Ministry of Health, Hanoi, Vietnam
| | - Anna Larson Williams
- Center for Global Health and Development, Boston University, Boston, MA, United States of America
| | - Tan Nguyen Van
- General Office for Population and Family Planning (GOPFP), Ministry of Health, Hanoi, Vietnam
| | - Marion McNabb
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
- Pathfinder International, Watertown, MA, United States of America
| | - Lien Tran Thi Ngoc
- Thái Nguyên Provincial Department of Public Health, Thái Nguyên City, Vietnam
| | - Ariel Falconer
- Center for Global Health and Development, Boston University, Boston, MA, United States of America
| | | | - Julia Rohr
- Center for Global Health and Development, Boston University, Boston, MA, United States of America
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Hai Hoang
- Thái Nguyên Provincial Department of Public Health, Thái Nguyên City, Vietnam
| | - James Michiel
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Tam Nguyen Thi Thanh
- Center for Population Research Information and Databases (CPRID), Ministry of Health, Hanoi, Vietnam
| | - Liat Bird
- Boston University School of Medicine, Boston, MA, United States of America
| | - Hoang Pham Vu
- Center for Population Research Information and Databases (CPRID), Ministry of Health, Hanoi, Vietnam
| | - Mahlet Yeshitla
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Nhu Ha Van
- Hanoi School of Public Health, Hanoi, Vietnam
| | - Lora Sabin
- Center for Global Health and Development, Boston University, Boston, MA, United States of America
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
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32
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Li H, Wang Z, Jiang N, Liu Y, Wen D. Lifelong learning of Chinese rural physicians: preliminary psychometrics and influencing factors. BMC MEDICAL EDUCATION 2015; 15:192. [PMID: 26519057 PMCID: PMC4628275 DOI: 10.1186/s12909-015-0460-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 10/09/2015] [Indexed: 05/11/2023]
Abstract
BACKGROUND There are more than 4.9 million rural health workers undertaking the health care need of rural population of over 629 million in China. The lifelong learning of physicians is vital in maintaining up-to-date and qualified health care, but rural physicians in many developing countries lack adequate medical professional developments. There has also been no empirical research focused on the lifelong learning of rural physician populations. The purpose of this study was to investigate the primary levels of lifelong learning of the rural physicians and to analyze group differences. METHODS We conducted a cross-sectional study on 1197 rural physicians using the Jefferson Scale of Physician Lifelong Learning (JSPLL). Cronbach's α coefficient, exploratory factor analysis, independent sample t-test, and one-way ANOVA followed by Student-Newman-Keuls test were performed to analyze the data. RESULTS For Chinese rural physicians, the JSPLL was reliable (Cronbach's α coefficient = 0.872) and valid, with exploratory factor analysis fitting a 3-factor model and accounting for a total of 60.46 % of the variance. The mean lifelong learning score was 45.56. Rural physicians generally performed worse in the technical skills in seeking information domain. Rural physicians with 21-30 working years have a lower score of lifelong learning (P < 0.05) than other phases of working years. Career satisfaction and professional titles had a significantly positive influence on physicians' orientation towards lifelong learning (P < 0.05). The overall lifelong learning scores of physicians who received more training after completion of medical school were higher than those with less additional post-medical school training (P <0.05). CONCLUSIONS The JSPLL is effective for the Chinese rural physician population. In order to cope with impacting factors on rural physicians' lifelong learning, the results of the study reinforced the importance of continuing medical education and career satisfaction for lifelong learning and the need for medical schools and hospitals to provide reasonable strategies and necessary support for rural physicians with different amounts of working years. Providing rural physicians more educational opportunities and helping them access educational resources may be an effective strategy for improving their orientation to lifelong learning.
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Affiliation(s)
- Honghe Li
- School of Public Health, China Medical University, Shenyang, Liaoning Province, China.
- Research Center for Medical Education, China Medical University, Shenyang, Liaoning Province, China.
| | - Ziwei Wang
- School of Public Health, China Medical University, Shenyang, Liaoning Province, China.
- Research Center for Medical Education, China Medical University, Shenyang, Liaoning Province, China.
| | - Nan Jiang
- Research Center for Medical Education, China Medical University, Shenyang, Liaoning Province, China.
| | - Yang Liu
- School of Public Health, China Medical University, Shenyang, Liaoning Province, China.
| | - Deliang Wen
- School of Public Health, Dalian Medical University, Dalian, Liaoning Province, China.
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