Cartoons for e-health informatics

Not only is Hepatitis B serology often misunderstood because of its complex serological implications, but advances in medical science have revolutionised screening and treatment of hepatitis B. To maximise such evolution however, this new information must be relayed effectively and efficiently to current and future medical professionals. Cartoons have been well regarded as a teaching tool in a variety of different settings as is the use of web based technology. Therefore the delivery of a cartoon based learning tool, accessed via on-line learning modules was considered a novel and potentially effective way of disseminating new knowledge. To increase health professionals’ understanding of hepatitis B serology and skill in interpreting the tests that indicate the appropriate treatment, a cartoon series was developed. The cartoons are located on an online educational website and include characters that represent the different antibodies and antigens associated with hepatitis B. The cartoon characters are involved in a series of adventures that represent the various phases of hepatitis B infection, and the paper describes their development. Subsequent research demonstrated that exposure to the online cartoon based learning tool indicates that they are a fun and useful way to increase knowledge

Improving health professional\u27s knowledge of hepatitis B using cartoon based learning tools: a retrospective analysis of pre and post tests

Background: Hepatitis B serology is complex and a lack of knowledge in interpretation contributes to the inadequate levels of screening and referral for highly effective hepatitis antiviral treatments. This knowledge gap needs to be addressed so that current and future healthcare professionals are more confident in the detection and assessment of hepatitis B to improve the uptake of treatment and reduce long-term complications from the disease. Cartoons have been used effectively as a teaching tool in other settings and were considered as a potentially useful teaching aid in explaining hepatitis B serology. This study examines the impact of cartoons in improving healthcare professionals’ knowledge. Methods: A cartoon based learning tool designed to simplify the complexities of hepatitis B serology was developed as part of an online learning program for medical practitioners, nurses and students in these professions. A retrospective analysis was carried out of pre and post online test results. Results: An average improvement of 96% of correct answers to case study questions in hepatitis B serology was found across all ten questions following the use of an online cartoon based learning tool. Conclusion: The data indicates a significant improvement of participants’ knowledge of hepatitis B serology from pre-test to post-test immediately following an online cartoon based learning tool. However, further research is required to measure its long term impact

Anxiety, depression, and comorbid anxiety and depression: Risk factors and outcome over two years

Background: This study aimed to determine: (1) the prevalence of depression, anxiety, and depression associated with anxiety (DA); (2) the risk factor profile of depression, anxiety, and DA; (3) the course of depression, anxiety, and DA over 24 months. Methods: Two-year longitudinal study of 20,036 adults aged 60+ years. We used the Patient Health Questionnaire and the Hospital Anxiety and Depression Scale anxiety subscale to establish the presence of depression and anxiety, and standard procedures to collect demographic, lifestyle, psychosocial, and clinical data. Results: The prevalence of anxiety, depression, and DA was 4.7%, 1.4%, and 1.8%. About 57% of depression cases showed evidence of comorbid anxiety, while only 28% of those with clinically significant anxiety had concurrent depression. There was not only an overlap in the distribution of risk factors in these diagnostic groups but also differences. We found that 31%, 23%, and 35% of older adults with anxiety, depression, and DA showed persistence of symptoms after two years. Repeated anxiety was more common in women and repeated depression in men. Socioeconomic stressors were common in repeated DA. Conclusions: Clinically significant anxiety and depression are distinct conditions that frequently coexist in later life; when they appear together, older adults endure a more chronic course of illness

Omics\u27 biomarkers associated with chronic low back pain: Protocol of a retrospective longitudinal study

Introduction Chronic low back pain (CLBP) produces considerable direct costs as well as indirect burdens for society, industry and health systems. CLBP is characterised by heterogeneity, inclusion of several pain syndromes, different underlying molecular pathologies and interaction with psychosocial factors that leads to a range of clinical manifestations. There is still much to understand in the underlying pathological processes and the non-psychosocial factors which account for differences in outcomes. Biomarkers that may be objectively used for diagnosis and personalised, targeted and cost-effective treatment are still lacking. Therefore, any data that may be obtained at the-omics\u27 level (glycomics, Activomics and genome-wide association studies-GWAS) may be helpful to use as dynamic biomarkers for elucidating CLBP pathogenesis and may ultimately provide prognostic information too. By means of a retrospective, observational, case-cohort, multicentre study, we aim to investigate new promising biomarkers potentially able to solve some of the issues related to CLBP. Methods and analysis The study follows a two-phase, 1:2 case-control model. A total of 12 000 individuals (4000 cases and 8000 controls) will be enrolled; clinical data will be registered, with particular attention to pain characteristics and outcomes of pain treatments. Blood samples will be collected to perform-omics studies. The primary objective is to recognise genetic variants associated with CLBP; secondary objectives are to study glycomics and Activomics profiles associated with CLBP. Ethics and dissemination The study is part of the PainOMICS project funded by European Community in the Seventh Framework Programme. The study has been approved from competent ethical bodies and copies of approvals were provided to the European Commission before starting the study. Results of the study will be reviewed by the Scientific Board and Ethical Committee of the PainOMICS Consortium. The scientific results will be disseminated through peer-reviewed journals. Trial registration number NCT02037789; Pre-results

Falls, Depression and Antidepressants in Later Life: A Large Primary Care Appraisal

BACKGROUND: Depression and falls are common and co-exist for older people. Safe management of each of these conditions is important to quality of life. METHODS: A cross-sectional survey was used to examine medication use associated with injurious and non-injurious falls in 21,900 community-dwelling adults, aged 60 years or over from 383 Australian general practices recruited for the DEPS-GP Project. Falls and injury from falls, medication use, depressive symptoms (Primary Health Questionnaire (PHQ-9)), clinical morbidity, suicidal ideation and intent, health status (SF-12 Health Survey), demographic and lifestyle information was reported in a standardised survey. FINDINGS: Respondents were 71.8 years (sd 7.7) of age and 58.4% were women. 24% 11% and 8% reported falls, fall related injury, and sought medical attention respectively. Antidepressant use (odds ratio, OR: 1.46; 95% confidence interval, 95%CI: 1.25, 1.70), questionable depression (5-14 on PHQ OR: 1.32, 95%CI: 1.13, 1.53) and clinically significant symptoms of depression (15 or more on PHQ OR: 1.70, 95%CI: 1.14, 1.50) were independently associated with multiple falls. SSRI use was associated with the highest risk of multiple falls (OR: 1.66, 95%CI: 1.36, 2.02) amongst all psychotropic medications. Similar associations were observed for injurious falls. Over 60% of those with four accumulated risk factors had multiple falls in the previous year (OR: 3.40, 95%CI: 1.79, 6.45); adjusted for other demographic and health factors. INTERPRETATION: Antidepressant use (particularly SSRIs) was strongly associated with falls regardless of presence of depressive symptoms. Strategies to prevent falls should become a routine part of the management of older people with depression

The quality of diagnosis and triage advice provided by free online symptom checkers and apps in Australia

Objectives To investigate the quality of diagnostic and triage advice provided by free website and mobile application symptom checkers (SC s) accessible in Australia. Design 36 SC s providing medical diagnosis or triage advice were tested with 48 medical condition vignettes (1170 diagnosis vignette tests, 688 triage vignette tests). Main outcome measures Correct diagnosis advice (provided in first, the top three or top ten diagnosis results); correct triage advice (appropriate triage category recommended). Results The 27 diagnostic SC s listed the correct diagnosis first in 421 of 1170 SC vignette tests (36%; 95% CI , 31–42%), among the top three results in 606 tests (52%; 95% CI , 47–59%), and among the top ten results in 681 tests (58%; 95% CI , 53–65%). SC s using artificial intelligence algorithms listed the correct diagnosis first in 46% of tests (95% CI , 40–57%), compared with 32% (95% CI , 26–38%) for other SC s. The mean rate of first correct results for individual SC s ranged between 12% and 61%. The 19 triage SC s provided correct advice for 338 of 688 vignette tests (49%; 95% CI , 44–54%). Appropriate triage advice was more frequent for emergency care (63%; 95% CI , 52–71%) and urgent care vignette tests (56%; 95% CI , 52–75%) than for non‐urgent care (30%; 95% CI , 11–39%) and self‐care tests (40%; 95% CI , 26–49%). Conclusion The quality of diagnostic advice varied between SC s, and triage advice was generally risk‐averse, often recommending more urgent care than appropriate

Pre-hospital advanced life support education – core components for pre-hospital professionals

Introduction: There is a broad evidence base supporting advanced life support (ALS) education to health care professionals to be structured, realistic and inclusive of a range of human factors. However, published literature largely focusses on ALS education within institutional settings such as hospitals and associated health care facilities, with typically predictable human and material resources. The aim of this paper is to explore the literature on ALS education and report the results of an international survey undertaken to identify those educational elements which differ in the pre-hospital setting compared to the institutional setting. High quality education in pre-hospital resuscitation is important because it is critical that pre-hospital professionals provide high quality ALS to maximise the likelihood of patient survival. Methods MEDLINE was searched using MESH terms ‘resuscitation’, ‘advanced life support’ and ‘prehospital’ as core terms. Fifteen articles relating specifically to pre-hospital resuscitation and a further 91 articles on resuscitation education were reviewed. Articles ranged in publication year from 1987 to 2016. An online survey on ALS education was developed and administered and attracted 177 responses from a range of health care professionals nationally and internationally. A total of 83 respondents completed the full survey. Results The literature identifies that best practice ALS education should (a) be taught in the environment in which ALS will be performed, (b) involve team members who are similar to those they will encounter while providing ALS, and (c) use equipment the provider uses in their workplace. Human factors, in particular leadership and communication, are important components of ALS education. However, results of the survey demonstrate that best practice is not well incorporated into pre-hospital ALS education. Conclusion: To improve pre-hospital patient outcomes and maximise the chances of patient survival, ALS education to pre-hospital providers should incorporate the context of their workplace (that is, the environment in which they function), the team members they regularly work with and the equipment they use in the pre-hospital setting. Human factors, in particular leadership, should be considered as part of pre-hospital resuscitation education

Ability of the Australian general public to identify common emergency medical situations: Results of an online survey of a nationally representative sample

Objective: To investigate the Australian general public\u27s ability to identify common medical emergencies as requiring an emergency response. Methods: An online survey asked participants to identify likely medical treatment pathways they would take for 17 hypothetical medical scenarios (eight emergency and nine non-emergency). The number and type of emergency scenarios participants correctly suggested warranted an emergency medical response was examined. Participants included Australian residents (aged \u3e 18 years; n = 5264) who had never worked as an Australian registered medical doctor, nurse or paramedic. Results: Most emergencies were predominately correctly classified as requiring emergency responses (e.g. Severe chest pain, 95 % correct). However, non-emergency medical responses were often chosen for some emergency scenarios, such as a child suffering from a scalp haematoma (67 %), potential meningococcal disease (57 %), a box jellyfish sting (40 %), a paracetamol overdose (37 %), and mild chest pain (26 %). Participants identifying as Aboriginal or Torres Strait Islander suggested a non-emergency response to emergency scenarios 29 % more often compared with non-indigenous participants. Conclusions: Educational interventions targeting specific medical symptoms may work to alleviate delayed emergency medical intervention. This research highlights a particular need for improving symptom identification and healthcare system confidence amongst Aboriginal and Torres Strait Islander populations