Evaluation of txt2MEDLINE and Development of Short Messaging Service–Optimized, Clinical Practice Guidelines in Botswana

Objective: Currently clinicians in sub-Saharan Africa have limited access to the Internet, whereas mobile phone access and use is extensive. The University of Pennsylvania in collaboration with the National Library of Medicine launched txt2MEDLINE, a short messaging service (SMS) query of PubMed/MEDLINE, and SMS-optimized clinical guidelines in Botswana. The objective of this project was to establish and evaluate the utility of these tools for clinicians in Botswana. Materials and Methods: A local server was established at the University of Botswana that allowed clinicians to send queries and receive results via local (in-country) SMS text messaging on any type of cellular phone. The queries sent via txt2MEDLINE were returned as abbreviated “the bottom line” summaries of abstracts. The 2007 Botswana Treatment Guide was converted into a format that can be queried by SMS. Various types of healthcare workers were recruited to use and evaluate these services. Results: Seventy-six healthcare workers attended training sessions for these services. In the preusage survey, most said they would use the services daily or weekly. During a 4-week trial period, use of these services dropped off dramatically. Participant feedback was collected and indicated that improvements in ease of use would increase the usage. Conclusions: This pilot project enables clinicians to query and receive PubMed abstract summaries and country-specific clinical guidelines using mobile phones. Feedback offers insight on how to improve this technology so that it can be adopted for long-term use. With further adjustments, these resources may provide an effective working model for other countries where limited Internet access impedes upon patient care

Use of Mobile Learning by Resident Physicians in Botswana

With the growth of mobile health in recent years, learning through the use of mobile devices (mobile learning [mLearning]) has gained recognition as a potential method for increasing healthcare providers\u27 access to medical information and resources in resource-limited settings. In partnership with the University of Botswana School of Medicine (SOM), we have been exploring the role of smartphone-based mLearning with resident (physicians in specialty training) education. The SOM, which admitted its first class of medical students and residents in 2009, is committed to providing high-level on-site educational resources for resident physicians, even when practicing in remote locations. Seven residents were trained to use an Android-based myTouch 3G smartphone equipped with data-enabled subscriber identity module (SIM) cards and built-in camera. Phones contained locally loaded point-of-care and drug information applications, a telemedicine application that allows for the submission of cases to local mentors, and e-mail/Web access. Surveys were administered at 4 weeks and 8 weeks following distribution of phones. We found that smartphones loaded with point-of-care tools are effectively utilized by resident physicians in resource-limited settings, both for accessing point-of-care medical information at the bedside and engaging in self-directed learning at home

Cytokine Gene Expression Profiles during Initiation, Progression and Resolution of Periodontitis

AIM: Variations in the expression of cytokines during the progression of periodontitis remain ill-defined. We evaluated the expression of 19 cytokine genes related to T-cell phenotype/function during initiation, progression and resolution of periodontitis, and related these to the expression of soft and bone tissue destruction genes (TDGs). MATERIALS AND METHODS: A ligature-induced periodontitis model was used in rhesus monkeys (M. mulatta) (n = 18). Gingival tissues were taken at baseline pre-ligation, 2 weeks and 1 month (Initiation) and 3 months (progression) post ligation. Ligatures were removed and samples taken 2 months later (resolution). Total RNA was isolated and the Rhesus Gene 1.0 ST (Affymetrix) used for gene expression analysis. Significant expression changes were validated by qRT-PCR. RESULTS: Disease initiation/progression was characterized by overexpression of Th17/Treg cytokine genes (IL-1β, IL-6, TGFβ and IL-21) and down-regulation of Th1/Th2 cytokine genes (IL-18 and IL-25). Increased IL-2 and decreased IL-10 levels were seen during disease resolution. Several Th17/Treg cytokine genes positively correlated with TDGs, whereas most Th1/Th2 genes exhibited a negative correlation. CONCLUSION: Initiation, progression and resolution of periodontitis involve over- and underexpression of cytokine genes related to various T-helper subsets. In addition, variations in individual T-helper response subset/genes during disease progression correlated with protective/destructive outcomes

Exploring how awareness of character strengths can benefit mental health nurses

This is the third in a series of articles that explores the meaning of positive psychology and the importance of applying the latest research findings for the wellbeing of the mental health workforce. It will focus on character strengths as a positive psychology intervention from its development to present day use and how it is relevant to mental health nursing. The activities provided in the boxes throughout the article will help the reader identify their own strengths and understand how to further develop their transferability to daily work, home life, education and recreation

Disseminating technology in global surgery.

BACKGROUND:Effective dissemination of technology in global surgery is vital to realize universal health coverage by 2030. Challenges include a lack of human resource, infrastructure and finance. Understanding these challenges, and exploring opportunities and solutions to overcome them, are essential to improve global surgical care. METHODS:This review focuses on technologies and medical devices aimed at improving surgical care and training in low- and middle-income countries. The key considerations in the development of new technologies are described, along with strategies for evaluation and wider dissemination. Notable examples of where the dissemination of a new surgical technology has achieved impact are included. RESULTS:Employing the principles of frugal and responsible innovation, and aligning evaluation and development to high scientific standards help overcome some of the challenges in disseminating technology in global surgery. Exemplars of effective dissemination include low-cost laparoscopes, gasless laparoscopic techniques and innovative training programmes for laparoscopic surgery; low-cost and versatile external fixation devices for fractures; the LifeBox pulse oximeter project; and the use of immersive technologies in simulation, training and surgical care delivery. CONCLUSION:Core strategies to facilitate technology dissemination in global surgery include leveraging international funding, interdisciplinary collaboration involving all key stakeholders, and frugal scientific design, development and evaluation

Telemedicine in Low Resource Settings

Telemedicine is a means to support health-care provision utilizing information and communication technology (ICT) tools and telecommunication services. This chapter focuses on telemedicine practices in low resource settings, referencing key telemedicine initiatives in Botswana. Telemedicine is highly practiced in the developed world, and recently there is an increasing interest in the developing world. Current literature suggests telemedicine as an important tool for improving healthcare delivery for low resource settings. Hence the authors' interest in exploring the current status of telemedicine practices with reference to telemedicine projects from low resource settings such as Botswana. The chapter reveals that telemedicine in such settings is mainly implemented through mobile phones, also known as mobile health (mHealth). In this chapter, the authors discuss factors influencing successful implementation of telemedicine solutions in Botswana. Furthermore, the chapter discusses telemedicine implementation challenges in each of the projects and presents possible mitigation strategies. The chapter concludes by affirming the feasibility of successfully practicing telemedicine in low resource settings; notwithstanding challenges such as lack of legal and eHealth frameworks in most developing countries. </jats:p

Telemedicine in Low Resource Settings

Telemedicine is a means to support health-care provision utilizing information and communication technology (ICT) tools and telecommunication services. This chapter focuses on telemedicine practices in low resource settings, referencing key telemedicine initiatives in Botswana. Telemedicine is highly practiced in the developed world, and recently there is an increasing interest in the developing world. Current literature suggests telemedicine as an important tool for improving healthcare delivery for low resource settings. Hence the authors' interest in exploring the current status of telemedicine practices with reference to telemedicine projects from low resource settings such as Botswana. The chapter reveals that telemedicine in such settings is mainly implemented through mobile phones, also known as mobile health (mHealth). In this chapter, the authors discuss factors influencing successful implementation of telemedicine solutions in Botswana. Furthermore, the chapter discusses telemedicine implementation challenges in each of the projects and presents possible mitigation strategies. The chapter concludes by affirming the feasibility of successfully practicing telemedicine in low resource settings; notwithstanding challenges such as lack of legal and eHealth frameworks in most developing countries. </jats:p