Smartphone apps for point-of-care information summaries: systematic assessment of the quality and content

Background Clinicians need easy access to evidence-based information to inform their clinical practice. Point-of-care information summaries are increasingly available in the form of smartphone apps. However, the quality of information from the apps is questionable as there is currently no regulation on the content of the medical apps. Objectives This study aimed to systematically assess the quality and content of the medical apps providing point-of-care information summaries that were available in two major app stores. We evaluated apps designed specifically for healthcare professionals and assessed their content development, editorial policy, coverage of medical conditions and trustworthiness. Methods We conducted a systematic assessment of medical apps providing point-of-care information summaries available in Google Play and Apple app stores. Apps launched or updated since January 2020 were identified through a systematic search using 42matters. Apps meeting the inclusion criteria were downloaded and assessed. The data extraction and app assessment were done in parallel and independently by at least two reviewers. Apps were evaluated against the adapted criteria: (1) general characteristics, (2) content presentation of the summaries, (3) editorial quality, (4) evidence-based methodology, (5) coverage (volume) of the medical conditions, (6) usability of apps and (7) trustworthiness of the app based on HONcode principles. HONcode principles are guidelines used to inform users about the credibility and reliability of health information online. The results were reported as a narrative review. Results Eight medical apps met the inclusion criteria and were systematically appraised. Based on our evaluation criteria, UpToDate supported 16 languages, and all other apps were English. Bullet points and brief paragraphs were used in all apps, and only DynaMed and Micromedex and Pathway-medical knowledge provided a formal grading system for the strength of recommendations for all the medical conditions in their apps. All the other apps either lacked a formal grading system altogether or offered one for some of the medical conditions. About 30% of the editorial quality assessment and 47.5% of the evidence-based methodology assessment were unclear or missing. UpToDate contained the most point-of-care evidence-based documents with >10 500 documents. All apps except 5-Minute Clinical Consult and DynaMed and Micromedex were available for offline access. Only Medscape complied with the HONcode principles. Conclusions Future apps should report a more detailed evidence-based methodology, be accessible for offline use and support search in more than one language. There should be clearer information provided in future apps regarding the declaration of authorship and conflict of interest

Information needs and information seeking behaviour of people with dementia and their non-professional caregivers: a scoping review

Background: People with dementia often require full-time caregivers especially in the later stages of their condition. People with dementia and caregivers’ access to reliable information on dementia is essential as it may have an important impact on patient care and quality of life. This study aims to provide an overview of the information needs and information seeking behaviour of people with dementia and their non-professional caregivers. Methods: We conducted a scoping review of the literature and searched four electronic databases for eligible studies published up to August 2018. Two reviewers independently screened studies and extracted data. Information needs were classified according to emerging themes in the literature, and information seeking behaviour was categorized using Wilson’s model of information behaviour. Results: Twenty studies with a total of 4,140 participants, were included in this review. Reported information needs focused on: (i) disease; (ii) patient care provision; (iii) healthcare services; and (iv) caregiver self-care. The most commonly reported information need was on healthcare service-related information. Characteristics found to influence information needs were the severity of dementia as well as patient and caregiver status. People with dementia and non-professional caregivers mainly displayed active searching, information seeking behaviour and preferred using electronic sources to obtain health information. Conclusion: Current dementia information sources available in English are extensive in the information they offer, but more emphasis needs to be placed on healthcare service-related information. All studies originated from high income countries and focused on information needs of non-professional caregivers only. The only variables found to be associated to information needs were severity of dementia condition as well as patient/caregiver status. The information needs identified in this review can be used to inform development and design of future dementia resources for people with dementia and their non-professional caregivers

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

Protocol for a scoping review on information needs and information-seeking behaviour of people with dementia and their non-professional caregivers

Background: Dementia is a debilitating disease that can lead to major changes in a patient’s behaviour and function. It is important to educate both dementia patients and their non-professional caregivers about the disease. Yet, currently available sources do not seem to be effective for patients and caregivers, who report a need for more information and guidance. A systematic identification of the patients’ and caregivers’ needs for information and information seeking behaviour is needed to create information resources that are relevant and beneficial to the target population. Objective: This is a protocol for a scoping review aimed at gathering knowledge on the information needs and information seeking behaviour of dementia patients and their non- professional caregivers. Our aim is also to provide recommendations for development of future dementia information resources. Methods: The study will commence in November 2018. Both quantitative and qualitative studies on the information needs of dementia patients or caregivers will be examined using Arksey and O’Malley’s methodological framework for scoping studies. A comprehensive literature search will be conducted in electronic databases and grey literature sources. We will also screen reference lists of included studies and related systematic reviews for additional eligible studies. Two authors will perform screening of citations for eligibility, and independently extract data from the included studies in parallel. Any discrepancies will be resolved through discussion. The findings will be presented through a narrative synthesis and reported in line with PRISMA reporting guidelines. Ethics and dissemination: In this review, all included data will originate from published literature. Ethics approval is therefore not a requirement. We will present our findings at relevant conferences and will submit them for publication in peer-reviewed journals. Strengths and limitations of this study • In this scoping review, we will perform a comprehensive search of electronic databases and grey literature sources to identify up-to-date evidence on information needs and information seeking behaviour of dementia patients and their informal caregivers. • We will seek to identify evidence on information needs and information seeking behaviour of both dementia patients and their caregivers. • As this is a scoping review, a formal quality and risk of bias assessment of the included literature will not be performed. • This review will only include studies published in English

Use of smartphones for detecting diabetic retinopathy: a protocol for a scoping review of diagnostic test accuracy studies

Introduction: Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus and the leading cause of impaired vision in adults worldwide. Early detection and treatment for DR could improve patient outcomes. Traditional methods of detecting DR include the gold standard Early Treatment Diabetic Retinopathy Study (ETDRS) seven standard fields fundus photography, ophthalmoscopy and slit-lamp biomicroscopy. These modalities can be expensive, difficult to access and require involvement of specialised healthcare professionals. With the development of mobile phone technology, there is a growing interest in their use for DR identification as this approach is potentially more affordable, accessible and easier to use. Smartphones can be employed in a variety of ways for ophthalmoscopy including the use of smartphone camera, various attachments and artificial intelligence for obtaining and grading of retinal images. The aim of this scoping review is to determine the diagnostic test accuracy of various smartphone ophthalmoscopy approaches for detecting DR in diabetic patients. Methods and analysis: We will perform an electronic search of MEDLINE, Embase and Cochrane Library for literature published from 2000 onwards. Two reviewers will independently analyse studies for eligibility and assess study quality using the QUADAS-2 tool. Data for a 2⨉2 contingency table will be extracted. If possible, we will pool sensitivity and specificity data using the random-effects model and construct a summary receiver operating characteristic (SROC) curve. In case of high heterogeneity, we will present the findings narratively. Subgroup analysis and sensitivity analysis will be performed where appropriate. Ethics and dissemination: This scoping review aims to provide an overview of smartphone ophthalmoscopy in DR identification. It will present findings on the accuracy of smartphone ophthalmoscopy in detecting DR, identify gaps in the literature and provide recommendations for future research. This review does not require ethical approval as we will not collect primary data

Public perceptions of diabetes, healthy living and conversational agents in Singapore: a needs assessment

Background: The incidence of chronic diseases such as type 2 diabetes is on the rise in countries worldwide, including Singapore. Health professional-delivered healthy lifestyle interventions have been shown to prevent type 2 diabetes. Yet ongoing personalised guidance from health professionals is not feasible or affordable at the population level. Novel digital interventions delivered using mobile technology such as conversational agents are a potential alternative for delivery of healthy lifestyle change behavioural interventions to the public. Objective: We explored Singaporeans’ perceptions on and experience of healthy living, diabetes and mobile health interventions (apps and conversational agents). This survey was done to help inform the design and development of a conversational agent focusing on healthy lifestyle change. Methods: This qualitative study was conducted over Aug and Sept 2019. 20 participants were recruited from relevant healthy living Facebook pages and groups. Semi-structured interviews were conducted in person or over the telephone using an interview guide. Interviews were transcribed and analysed in parallel by two researchers using Burnard’s method, a structured approach for thematic content analysis. Results: The collected data was organised into four main themes: (1) use of conversational agents, (2) ubiquity of smartphone applications, (3) understanding of diabetes and (4) barriers and facilitators to a healthy living in Singapore. Most participants used health-related mobile applications as well as conversational agents unrelated to healthcare. They provided diverse suggestions for future conversational agent-delivered interventions. Participants also highlighted several knowledge gaps in relation to diabetes and healthy living. In terms of barriers to healthy living, frequent dining out, high stress levels, lack of work-life balance and dearth of free time to engage in physical activity were mentioned. In contrast, discipline, pre-planning and sticking to a routine were important for enabling a healthy lifestyle. Conclusions: Participants in our study commonly used mobile health interventions and provided important insights into their knowledge gaps and needs in relation to healthy lifestyle behaviour change. Future digital interventions like conversational agents focusing on healthy lifestyle and diabetes prevention should aim to address the barriers highlighted in our study and motivate individuals to adopt habits for healthy living

Health Literacy and Health Outcomes in Patients with Low Back Pain – A Scoping Review

BACKGROUND: Low back pain is a leading cause of disability worldwide. Health literacy has been associated with pain intensity and pain control. However, there is a paucity of evidence regarding this association. In the field of low back pain research, inconsistent reporting of outcomes has been highlighted. To address this issue a Core Outcome Set has been developed. OBJECTIVES: The objectives of this scoping review were: (1) The health literacy measures currently employed for low back pain and the aspects of health literacy they include. (2) The low back pain health outcomes included in such work. (3) The extent to which these health outcomes reflect the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain. METHODS: The search included thirteen bibliographic databases, using medical subject heading terms for low back pain and health literacy, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The eligibility criteria were defined by the Joanna Briggs Institute PCC mnemonic. A thematic framework approach was used for analysis. RESULTS: The search yielded ten relevant studies for inclusion, amongst which a total of nine health literacy measures and 50 health outcome measures were used. Most health literacy measures focused on functional health literacy, with few assessing communicative and critical health literacy. The health outcomes assessed by the included studies could be broadly categorised into: Pain, Disability, Behaviour, Knowledge and Beliefs, and Resource Utilisation. Most of these outcome measures studied (36 out of 50) did not directly reflect the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain. CONCLUSIONS: To allow for comparison across findings and the development of a rigorous evidence base, future work should include the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain. There is an urgent need to broaden the evidence-base to include regions where low back pain morbidity is high, but data is lacking. Such work demands the incorporation of comprehensive measures of health literacy that have both generic and culturally sensitive components

Prioritizing problems in and solutions to homecare safety of people with dementia:supporting carers, streamlining care

Abstract Background Dementia care is predominantly provided by carers in home settings. We aimed to identify the priorities for homecare safety of people with dementia according to dementia health and social care professionals using a novel priority-setting method. Methods The project steering group determined the scope, the context and the criteria for prioritization. We then invited 185 North-West London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to homecare safety of people with dementia. 76 clinicians submitted their suggestions which were thematically synthesized into a composite list of 27 distinct problems and 30 solutions. A group of 49 clinicians arbitrarily selected from the initial cohort ranked the composite list of suggestions using predetermined criteria. Results Inadequate education of carers of people with dementia (both family and professional) is seen as a key problem that needs addressing in addition to challenges of self-neglect, social isolation, medication nonadherence. Seven out of top 10 problems related to patients and/or carers signalling clearly where help and support are needed. The top ranked solutions focused on involvement and education of family carers, their supervision and continuing support. Several suggestions highlighted a need for improvement of recruitment, oversight and working conditions of professional carers and for different home safety-proofing strategies. Conclusions Clinicians identified a range of suggestions for improving homecare safety of people with dementia. Better equipping carers was seen as fundamental for ensuring homecare safety. Many of the identified suggestions are highly challenging and not easily changeable, yet there are also many that are feasible, affordable and could contribute to substantial improvements to dementia homecare safety

Integrating Prevention of Mother-to-Child HIV Transmission Programs to Improve Uptake: A Systematic Review

BACKGROUND: We performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries. METHODS: We searched for experimental, quasi-experimental and controlled observational studies in any language from 21 databases and grey literature sources. RESULTS: Out of 28 654 citations retrieved, five studies met our inclusion criteria. A cluster randomized controlled trial reported higher probability of nevirapine uptake at the labor wards implementing HIV testing and structured nevirapine adherence assessment (RRR 1.37, bootstrapped 95% CI, 1.04-1.77). A stepped wedge design study showed marked improvement in antiretroviral therapy (ART) enrolment (44.4% versus 25.3%, p<0.001) and initiation (32.9% versus 14.4%, p<0.001) in integrated care, but the median gestational age of ART initiation (27.1 versus 27.7 weeks, p = 0.4), ART duration (10.8 versus 10.0 weeks, p = 0.3) or 90 days ART retention (87.8% versus 91.3%, p = 0.3) did not differ significantly. A cohort study reported no significant difference either in the ART coverage (55% versus 48% versus 47%, p = 0.29) or eight weeks of ART duration before the delivery (50% versus 42% versus 52%; p = 0.96) between integrated, proximal and distal partially integrated care. Two before and after studies assessed the impact of integration on HIV testing uptake in antenatal care. The first study reported that significantly more women received information on PMTCT (92% versus 77%, p<0.001), were tested (76% versus 62%, p<0.001) and learned their HIV status (66% versus 55%, p<0.001) after integration. The second study also reported significant increase in HIV testing uptake after integration (98.8% versus 52.6%, p<0.001). CONCLUSION: Limited, non-generalizable evidence supports the effectiveness of integrated PMTCT programs. More research measuring coverage and other relevant outcomes is urgently needed to inform the design of services delivering PMTCT programs

The Uptake of Integrated Perinatal Prevention of Mother-to-Child HIV Transmission Programs in Low- and Middle-Income Countries: A Systematic Review

BACKGROUND: The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries. METHODS AND FINDINGS: We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30-100%) and 81% (range 26-100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22-99%) and 60% (range 19-100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44-100%) of infants were tested for HIV and 11% (range 3-18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis. CONCLUSION: The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed