The role of eLearning in health management and leadership capacity building in health system: a systematic review

Background Health leadership and management are essential for ensuring resilient health systems. Relevant training opportunities are often scarce, and the use of digital education could help address this gap. Our aim was to assess the effectiveness of eLearning for healthcare leadership and management capacity building. Methods We performed a systematic review on the effectiveness of eLearning for health leadership and management training. We also reviewed literature on relevant competencies and training programmes. We conceptualise the role of health leadership and management capacity building in health system strengthening and explore the use of eLearning in this area. Results No evidence was found on the effectiveness of eLearning for health leadership and management capacity guiding. Evidence on health leadership and management education effectiveness in general is scarce and descriptive and reports learning outcomes. We explore how various forms of eLearning can help meet specific requirements of health leadership and management training. Conclusions Literature on the effectiveness of health leadership and management education is scarce. The use of eLearning could support this type of training by making it more accessible and tailored. Future research should be carried out in diverse settings, assume experimental designs, evaluate the use of information technology and report health system outcomes

Genetic diversity of Brazilian isolates of feline immunodeficiency virus

We isolated Feline immunodeficiency virus (FIV) from three adult domestic cats, originating from two open shelters in Brazil. Viruses were isolated from PBMC following co-cultivation with the feline T-lymphoblastoid cell line MYA-1. All amplified env gene products were cloned directly into pGL8MYA. The nucleic acid sequences of seven clones were determined and then compared with those of previously described isolates. The sequences of all of the Brazilian virus clones were distinct and phylogenetic analysis revealed that all belong to subtype B. Three variants isolated from one cat and two variants were isolated from each of the two other cats, indicating that intrahost diversity has the potential to pose problems for the treatment and diagnosis of FIV infection

Reversal of Tetracycline Resistance by Cepharanthine, Cinchonidine, Ellagic Acid and Propyl Gallate in a Multi-drug Resistant Escherichia coli

Bacterial resistance to antibiotics is an increasing threat to global healthcare systems. We therefore sought compounds with potential to reverse antibiotic resistance in a clinically relevant multi-drug resistant isolate of Escherichia coli (NCTC 13400). 200 natural compounds with a history of either safe oral use in man, or as a component of a traditional herb or medicine, were screened. Four compounds; ellagic acid, propyl gallate, cinchonidine and cepharanthine, lowered the minimum inhibitory concentrations (MICs) of tetracycline, chloramphenicol and tobramycin by up to fourfold, and when combined up to eightfold. These compounds had no impact on the MICs of ampicillin, erythromycin or trimethoprim. Mechanistic studies revealed that while cepharanthine potently suppressed efflux of the marker Nile red from bacterial cells, the other hit compounds slowed cellular accumulation of this marker, and/or slowed bacterial growth in the absence of antibiotic. Although cepharanthine showed some toxicity in a cultured HEK-293 mammalian cell-line model, the other hit compounds exhibited no toxicity at concentrations where they are active against E. coli NCTC 13400. The results suggest that phytochemicals with capacity to reverse antibiotic resistance may be more common in traditional medicines than previously appreciated, and may offer useful scaffolds for the development of antibiotic-sensitising drugs

Primaquine in vivax malaria: an update and review on management issues

Primaquine was officially licensed as an anti-malarial drug by the FDA in 1952. It has remained the only FDA licensed drug capable of clearing the intra-hepatic schizonts and hypnozoites of Plasmodium vivax. This update and review focuses on five major aspects of primaquine use in treatment of vivax malaria, namely: a) evidence of efficacy of primaquine for its current indications; b) potential hazards of its widespread use, c) critical analysis of reported resistance against primaquine containing regimens; d) evidence for combining primaquine with artemisinins in areas of chloroquine resistance; and e) the potential for replacement of primaquine with newer drugs

Digitally competent health workforce: a scoping review of educational frameworks

Background: Digital health technologies can be key to improving health outcomes, provided health workers are adequately trained to utilize these technologies. There have been efforts to identify digital competencies for different health worker groups, however, an overview of these efforts has yet to be consolidated and analysed. Objective: The objective of this review is to identify and study the existing digital health competency frameworks for health workers and provide recommendations for future digital health training initiatives and framework development. Methods: A literature search was performed to collate digital health competency frameworks published from year 2000. Six databases, including grey literature sources such as OpenGrey, ResearchGate, Google Scholar, Google, and websites of relevant associations were searched in November 2019. Screening and data extraction were performed in parallel by reviewers. The included evidence is narratively described in terms of characteristics, evolution, and structural composition of frameworks. A thematic analysis was also performed to identify common themes across the included frameworks. Findings: Thirty frameworks were included in this review, a majority of which aimed at nurses, originated from high-income countries, published since 2016 and developed via literature reviews, followed by expert consultations. The thematic analysis uncovered 28 digital health competency domains across the included frameworks. The most prevalent domains were pertaining to basic IT literacy, health information management, digital communication, ethical/legal/regulatory requirements, and data privacy/security. The HITCOMP framework was found to be the most comprehensive framework, as it presented 21 out of the 28 identified domains, had the highest number of competencies, and targeted a wide variety of health workers. Conclusions: Digital health training initiatives should focus on competencies relevant to a particular health worker group, role, level of seniority and setting. The findings from this review can inform and guide digital health training initiatives. The most prevalent competency domains identified represent essential interprofessional competencies to be incorporated into health workers’ training. Digital health frameworks should be regularly updated with novel digital health technologies, applicable to low- and middle-income countries, and include overlooked health worker groups such as allied health professionals

The use of smartphones to detect diabetic retinopathy: a scoping review and meta-analysis of diagnostic test accuracy studies

Background: Diabetic retinopathy (DR), a common complication of diabetes mellitus, is the leading cause of impaired vision in adults worldwide. Smartphones ophthalmoscopy involves using a smartphone camera for digital retinal imaging. Utilizing smartphones to detect DR is potentially more affordable, accessible and easier to use than conventional methods. Objective: To determine the diagnostic accuracy of various smartphone ophthalmoscopy approaches for detecting DR in diabetic patients. Methods: We performed an electronic search on MEDLINE, Embase and Cochrane Library for literature published from January 2000 to November 2018. We included studies involving diabetic patients which compared the diagnostic accuracy of smartphone ophthalmoscopy for detecting DR, to an accurate or commonly-employed reference standard, e.g. indirect ophthalmoscopy, slit-lamp biomicroscopy and tabletop fundus photography. Two reviewers independently screened studies against the inclusion criteria, extracted data and assessed the quality of included studies using the QUADAS-2 tool, with disagreements resolved via consensus. Sensitivity and specificity were pooled using the random-effects model. A summary receiver operating characteristic (SROC) curve was constructed. This review is reported in line with the PRISMA-DTA guidelines. Results: Nine studies involving 1430 participants were included. Most were of high quality, except one study with limited applicability due to its reference standard. The pooled sensitivity and specificity for detecting: any DR was 87% (95% CI 74%–94%) and 94% (81%–98%); mild non-proliferative DR (NPDR) was 39% (10%–79%) and 95% (91%–98%); moderate NPDR was 71% (57%–81%) and 95% (88%–98%); severe NPDR was 80% (49%–94%) and 97% (88%–99%); PDR was 92% (79%–97%) and 99% (96%–99%); diabetic macular edema was 79% (63%–89%) and 93% (82%–97%); and referral-warranted DR was 91% (86%–94%) and 89% (56%–98%). The area under SROC curve ranged from 0.879–0.979. The diagnostic odds ratio ranged from 11.3–1225. Conclusion: We found heterogeneous evidence showing smartphone ophthalmoscopy performs well in detecting DR. The diagnostic accuracy for PDR was highest. Future studies should standardize reference standards and classification criteria, and evaluate other available forms of smartphone ophthalmoscopy in primary care settings

Need for Improved Definition of "Chronic Wounds" in Clinical Studies.

The term “chronic wound” was first used in the literature in the 1950s, to refer to wounds that were difficult to heal or did not follow a normal healing process (1, 2). However, the term has met criticism for its uncertainty regarding the duration of chronicity (3). Various alternative terminologies have been suggested, such as hard-to-heal wounds, difficult to heal wounds, non-healing wounds and complex wounds (4, 5). “Chronic wounds” are commonly defined as “wounds that have not proceeded through an orderly and timely reparation to produce anatomic and functional integrity after 3 months” (6). However, Martin & Nunan (7) defined a “chronic wound” as a barrier defect that has not healed in 3 months, and Leaper & Durani (8) defined it as a wound that lacks a 20–40% reduction in size after 2–4 weeks of optimal treatment or when there is not complete healing after 6 weeks. Recent reviews have also highlighted the lack of consensus regarding the definition of a “chronic wound” and the need for further research in this area (9, 10).ASTAR (Agency for Sci., Tech. and Research, S’pore)Published versio

Digital education for the management of chronic wounds in healthcare professions’ education: A protocol for a systematic review by Digital Health Education Collaboration

Background: Digital education is “an approach to teaching and learning, representing all or part of the educational model applied, that is based on the use of electronic media and devices as tools for improving access to training, communication and interaction and that facilitates the adoption of new ways of understanding and developing learning”. Digital education comprises a wide range of interventions that can be broadly divided into offline digital education, online digital education, digital game-based learning, massive open online courses (MOOCs), psychomotor skills trainers, virtual reality environments, virtual patient simulations, and mLearning. Chronic wounds pose an immense economic and psychosocial burden to patients and the healthcare system as caring for them require highly specialized personnel. Current training strategies, face significant barriers, such as lack of time due to work commitments, distance from provider centres and costs. Therefore, there is a need to evaluate novel approaches to increase the effectiveness of learning programs on chronic wound management available to healthcare professionals. Objective: Our main objective is to assess the effectiveness of digital education, as a standalone or as part of a blended learning approach in improving pre- and post-registration healthcare professionals’ knowledge, attitudes, practical skills, and behaviour in the management of chronic wounds, and their satisfaction with the intervention. Secondary objectives are to evaluate patient related outcomes, cost-effectiveness of the interventions, and any unfavourable or undesirable outcomes that may arise. Methods: This systematic review will follow Cochrane methodology. Two independent reviewers will screen the library for included studies. We will describe the screening process using a flowchart as per PRISMA guidelines. We will extract the data using a previously developed, structured data extraction form. Included studies will be quality assessed using the Risk of Bias tool by Cochrane. We will narratively summarize the data, and if it is possible, we will conduct a meta-analysis. Results: We are currently screening full text papers against our inclusion and exclusion criteria. We are expecting to complete our review in the next three to four months. Conclusions: This systematic review will provide an in-depth analysis of digital education strategies to train healthcare providers in the management of chronic wounds. We consider this topic particularly relevant given the current challenges facing healthcare systems worldwide: shortages of skilled personnel and steep increase of older adults due to an increase in life expectancy. ClinicalTrial: This protocol has been registered with PROSPERO. Registration ID: CRD4201810997