Integration of overseas-trained doctors into the Australian medical workforce

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included. See page 7 of PDF for this item.Linsey S Hart, Jane Vernon-Robert

Systematic review on the prevalence, frequency and comparative value of adverse events data in social media

Aim: The aim of this review was to summarize the prevalence, frequency and comparative value of information on the adverse events of healthcare interventions from user comments and videos in social media. Methods: A systematic review of assessments of the prevalence or type of information on adverse events in social media was undertaken. Sixteen databases and two internet search engines were searched in addition to handsearching, reference checking and contacting experts. The results were sifted independently by two researchers. Data extraction and quality assessment were carried out by one researcher and checked by a second. The quality assessment tool was devised in-house and a narrative synthesis of the results followed. Results: From 3064 records, 51 studies met the inclusion criteria. The studies assessed over 174 social media sites with discussion forums (71%) being the most popular. The overall prevalence of adverse events reports in social media varied from 0.2% to 8% of posts. Twenty-nine studies compared the results from searching social media with using other data sources to identify adverse events. There was general agreement that a higher frequency of adverse events was found in social media and that this was particularly true for ‘symptom’ related and ‘mild’ adverse events. Those adverse events that were under-represented in social media were laboratory-based and serious adverse events. Conclusions: Reports of adverse events are identifiable within social media. However, there is considerable heterogeneity in the frequency and type of events reported, and the reliability or validity of the data has not been thoroughly evaluated

The prevalence of bacterial contamination in donated blood in Dar es salaam, Tanzania

Blood transfusion services are required to provide blood and components which are safe in cost effective way for transfusion into patients who require the blood products. This study aims to determine the prevalence of bacterial contamination and the antimicrobial resistance pattern in collected blood in Eastern zone blood transfusion centre. A cross-sectional study was conducted at Eastern Zone Blood Transfusion Services located at Mchikichini, Ilala District, in Dar es Salaam. Stored whole blood bags were selected from the refrigerator containing 500 blood bags using a simple random sampling technique. About 384 blood bags were randomly picked for study, each blood bag was given an ID number (1-500), and a table of random numbers was used to select the 384 donated blood bags. Culture was done on different media; isolates were identified using standard biochemical and bacteriological methods. Kirby- Bauer disk diffusion method was used for antimicrobial susceptibility testing according to existing guidelines of CLSI. Data entry and analysis were performed using EpiInfo 3.5.1. About 11 (2.8%) were found to have bacterial contamination, of which 9 (2.3%) were gram positive cocci and 2 (0.5%) gram positive rods. The bacterial isolates were about 7 (63.6%) coagulase negative staphylococci identified as Staphylococcus epidermidis and 2 (18.2%) were micro cocci identified as M.luteus and bacilli species identified as Corynebacterium diphtheroids. Sensitivity among the organisms were varied; as all the 11 (100%) of the organisms isolated were sensitive to amikacin, of which 7 (100%) Staphylococcus epidermidis were sensitive to ciprofloxacin, gentamycine, cefriaxone, erythromycin and co-trimoxazole. Gram positive rods were tested against erythromycin and Gentamycine; where 100% were sensitive to Gentamycine and (60.5%) were sensitive to erythromycin. M.luteus were tested against ceftriaxone and gentamycin had (98%) and (97.5%) sensitivity to these antibiotics respectively. Gram positive rods showed (100%) resistant to ampicilin, cotrimoxazole and tetracycline The isolates obtained in the donated blood are skin associated organisms and are considered as contaminants related to procedure during donor bleeding or taking sample for culture

Pharmacovigilance of pregnancy exposures to medicinal products focusing on the risk of orofacial clefts

Background: It is important to obtain robust scientific information on possible safety concerns related to the use of drugs during pregnancy in post-approval settings. Since pregnant women are actively excluded from trials in the clinical development of most products, at the time of the drug entry in the market meaningful human data on the effects of that drug during pregnancy are rarely available. There are approximately 5 million pregnancies in the EU each year, and about 1 in every 10 women of childbearing age is pregnant each year. Insufficient information for management of maternal disease during pregnancy can have teratogenic impact on fetus. Aim and objectives: This reach comprises three studies, in the first study; the goal was to evaluate the maternal use of medicines and the associated risks of cleft lip and/or palate in fetus and to link this to the accuracy and currency of safety information available in prescribing information. The second area of research was aimed at identifying and exploring social and digital media to understand patients’ experiences regarding medicine use during pregnancy. Last, but not least, I contributed to the development of an enhanced pharmacovigilance programme for analysing drug exposure during pregnancy and outcomes in neonate. Method: Firstly, I identified medication-induced risk factors for oral clefts with safety signal detection and safety signal evaluation techniques. Then I assessed the completeness of the safety information for pregnancy exposures in the Summary of Product Characteristics and the Patient Information in the UK and the US. In second study, the content of posts concerning pregnancy and use of medicines in online pregnancy forums was analysed using artificial intelligence in the form of natural language processing and machine learning algorithms. Third, the PRIM (PRegnancy outcomes Intensive Monitoring) system was developed as an enhanced pharmacovigilance data collection method. This was used to improve the quality and content of prospective case reports using sets of targeted checklists, structured follow-up, a rigorous process of data entry and data quality control, and programmed aggregate analysis. Results: For 12 antiepileptic drugs studied there was a statistical disproportionality in individual case safety reports indicative of an increased risk of cleft lip and/or palate. There are inconsistencies between the UK and US safety labels, despite the same evidence being available for assessment. The second study showed that in social media forums many pregnant women with MS shared profound uncertainties and specific concerns about taking medicines during the reproductive period. There was evidence of concealment of information with health care professionals; however, the same evidence was shared with a peer group. The PRIM method of enhanced pharmacovigilance has yielded substantially more information on the safety of fingolimod exposure during pregnancy than has been achieved via the regulatory authority-mandated pregnancy registry. Conclusion: Use of medicines during pregnancy is an important topic for public health. There is a significant need to provide inclusive, unbiased, up to- date information to prescribers and women of childbearing age concerning the use of medicines in pregnancy and postpartum during breastfeeding. Information must be provided in a timely manner by a trusted source and patients should have access to health care professionals with the relevant expertise and knowledge. It is important that the full anonymised data set, along with evidence-based conclusions are made publicly available to inform decision-making

The Odyssey of Dental Anxiety: From Prehistory to the Present. A Narrative Review

Dental anxiety (DA) can be considered as a universal phenomenon with a high prevalence worldwide; DA and pain are also the main causes for medical emergencies in the dental office, so their prevention is an essential part of patient safety and overall quality of care. Being DA and its consequences closely related to the fight-or-flight reaction, it seems reasonable to argue that the odyssey of DA began way back in the distant past, and has since probably evolved in parallel with the development of fight-or-flight reactions, implicit memory and knowledge, and ultimately consciousness. Basic emotions are related to survival functions in an inseparable psychosomatic unity that enable an immediate response to critical situations rather than generating knowledge, which is why many anxious patients are unaware of the cause of their anxiety. Archeological findings suggest that humans have been surprisingly skillful and knowledgeable since prehistory. Neanderthals used medicinal plants; and relics of dental tools bear witness to a kind of Neolithic proto-dentistry. In the two millennia BC, Egyptian and Greek physicians used both plants (such as papaver somniferum) and incubation (a forerunner of modern hypnosis, e.g., in the sleep temples dedicated to Asclepius) in the attempt to provide some form of therapy and painless surgery, whereas modern scientific medicine strongly understated the role of subjectivity and mind-body approaches until recently. DA has a wide range of causes and its management is far from being a matter of identifying the ideal sedative drug. A patient's proper management must include assessing his/her dental anxiety, ensuring good communications, and providing information (iatrosedation), effective local anesthesia, hypnosis, and/or a wise use of sedative drugs where necessary. Any weak link in this chain can cause avoidable suffering, mistrust, and emergencies, as well as having lifelong psychological consequences. Iatrosedation and hypnosis are no less relevant than drugs and should be considered as primary tools for the management of DA. Unlike pharmacological sedation, they allow to help patients cope with the dental procedure and also overcome their anxiety: achieving the latter may enable them to face future dental care autonomously, whereas pharmacological sedation can only afford a transient respite

Toward improving adverse drug reactions reporting from Twitter

Adverse Drug Reaction (ADR) has become a central concern for many healthcare providers [15]. It is well-known that adverse reactions to drugs are a rea-son for several health problems. According to the Food and Drug Administration (FDA) estimation, ADRs are the 4th leading cause of death [15]. The prevalence of ADRs necessitates the establishment of a simple ADR reporting process. The ADR reporting process involves many stakeholders such as the FDA, the patient, and the health professional. The research uncovered a significant lack of communication among the stakeholders, thus the research goal is to improve this lack in communication. This research focuses on how to improve ADR reporting based on patients' posts on Twitter and also what solution can be provided to improve the communication between the patient and the doctor during the ADR reporting process. Therefore, this study proposes a solution to enhance such the communication between the stakeholders

Mining social media data for biomedical signals and health-related behavior

Social media data has been increasingly used to study biomedical and health-related phenomena. From cohort level discussions of a condition to planetary level analyses of sentiment, social media has provided scientists with unprecedented amounts of data to study human behavior and response associated with a variety of health conditions and medical treatments. Here we review recent work in mining social media for biomedical, epidemiological, and social phenomena information relevant to the multilevel complexity of human health. We pay particular attention to topics where social media data analysis has shown the most progress, including pharmacovigilance, sentiment analysis especially for mental health, and other areas. We also discuss a variety of innovative uses of social media data for health-related applications and important limitations in social media data access and use.Comment: To appear in the Annual Review of Biomedical Data Scienc

Knowledge, attitudes and perceptions regarding lymphatic filariasis: study on systematic noncompliance with mass drug administration

The aim of this study was to investigate the epidemiological characteristics, antigenic profile, perceptions, attitudes and practices of individuals who have been systematically non-compliant in mass drug administration (MDA) campaigns targeting lymphatic filariasis, in the municipality of Olinda, State of Pernambuco, Northeastern Brazil. A pretested questionnaire was used to obtain information on socioenvironmental demographics, perceptions of lymphatic filariasis and MDA, and reasons for systematic noncompliance with treatment. A rapid immunochromatographic test (ICT) was performed during the survey to screen for filariasis. It was found that the survey subjects knew about filariasis and MDA. Filariasis was identified as a disease (86.2%) and 74.4% associated it with the presence of swelling in the legs. About 80% knew about MDA, and the main source of information was healthcare workers (68.3%). For men the main reasons for systematic noncompliance with MDA were that “the individual had not received the medication” (p=0.03) and for women “the individual either feared experiencing adverse reactions”. According to the ICT, the prevalence of lymphatic filariasis was 2%. The most important causes of systematic noncompliance were not receiving the drug and fear of side-effects. For successful implementation of MDA programs, good planning, educational campaigns promoting the benefits of MDA, adoption of measures to minimize the impact of adverse effects and improvement of drug distribution logistics are needed