Buddhika Senanayake

Historically, telemedicine research is predominantly published in discipline-specific telemedicine journals. However, in recent times the number of publications on telemedicine in clinical journals has increased. Acceptance of telemedicine research by clinical journals indicates a maturing of the telemedicine field. This bibliometric study reviewed telemedicine-related literature published in clinical journals from 2008 to 2018. A search was conducted in PubMed using two types of clinical outlets. (1) Top 20 journals with highest Impact Factor in the field of Medicine. (2) Top five journals with highest Impact Factor in most common Medical Specialty Areas. Analysis showed that there is a steady growth of literature relating to research and non-research publications appearing in clinical journals. Top five journals in the field of Medicine – BMJ, JAMA, Cochrane database, Medical Journal of Australia and Lancet have published 64% (n = 270) of telemedicine-related articles for the study period. Disease areas associated with telemedicine publications are consistent with global disease priorities. The review demonstrated that the most significant increase in telemedicine research published in clinical journals was focused on patient care.

Digital health – the convergence of digital technologies within health and health care to enhance the efficiency of health-care delivery – is fast becoming an integral part of routine medical practice. The integration of digital health into traditional practice brings significant changes. Logic dictates that for medical practitioners to operate in this new digitally enabled environment, they require specific knowledge, skills and competencies relating to digital health. However, very few medical programmes in Australia and globally include digital health within their regular curriculum. This pilot study aimed to explore medical students’ perceptions and expectations of digital health education and training (ET). An online survey and focus groups were used to collect information about medical students’ perceptions and expectations relating to digital health and ET relating to this field within the medical programme at the University of Queensland. Sixty-three students took part in the survey, and 17 students were involved in four focus groups. Most participants had no formal ET in digital health. Most participants (n = 43; 68%) expressed a willingness to learn about digital health as part of their medical programme. Primarily, knowledge- and practice-related factors have motivated students to learn about digital health. The analysis of focus group data identified two superordinate themes: (a) drivers of digital health ET and (b) expectations relating to digital health ET. Students agreed that digital health is a relevant field for their future practice that should be taught as part of their regular curriculum.

Digital health is quickly becoming an integral part of healthcare services. Research evidence suggests that digital health can benefit stakeholders involved in healthcare including patients and care providers. As digital health continues to integrate into routine healthcare, practitioners may require new knowledge, skills, and competencies to make the best use of it and to be able to communicate with an increasingly digitally enabled consumer. While much effort has been made to systematic education and training relating to digital health, which is an important aspect in developing the digital health workforce, it is important that governments and health systems consider digital health education and training as an important element in the process of implementing digital health within health services. Digital health education must be given its due recognition and support so that the future heath workforce has an opportunity to develop required knowledge and skills relating to digital health.

The benefits that digital health may offer include clinical, administrative, research, and educational. Research shows that if used in the right circumstances, digital health may increase access to healthcare services, improve clinical outcomes, safety, and quality of care. Digital health also has the potential to improve organisational efficiencies by reducing duplication and unnecessary diagnostic testing. From a healthcare consumer perspective, there is an expectation that healthcare services need to be provided in a more flexible and cost-effective way as in other spheres such as banking, commerce, and media. This is another important driver for consideration to integrate digital health in healthcare services. As digital health continues to be used in routine healthcare services, practitioners may require new knowledge, skills, and competencies to make the best use of this innovative method. Education and training relating to digital health have been recognised as a priority for developing the future healthcare workforce.

Digital health is fast becoming an integral part of healthcare services. Research evidence suggests that digital health can benefit stakeholders involved in healthcare, including patients and care providers. As digital health continues to integrate into routine healthcare, practitioners may require new knowledge, skills, and competencies to make the best use of it and to be able to communicate with an increasingly digitally-enabled consumer. Much effort has been made to systematic education and training relating to digital health, an important aspect in developing the digital health workforce.

Indian J Psychol Med, Official publication of Indian Psychiatric Society, South Zone

Background: Tuberculosis (TB) is a major global health problem, commonly seen in underdeveloped countries. The probability of contracting the disease is significantly higher among the economically vulnerable and the socially disadvantaged. Risk factors associated with TB can also change over time. In the Sri Lankan context, no study has explored how these factors impact patients. Therefore, we aimed to explore social status, associated risk factors and lifestyle changes during the treatment period of TB patients attending a tertiary respiratory center in Colombo, Sri Lanka. Methods: The descriptive cross-sectional study was conducted in 2011. The study population consisted of diagnosed tuberculosis patients above the age of 15 years. Patient records were retrieved from the TB patient registry for the Colombo district. Systematic sampling was used to identify patients to be invited to the study. An interviewer-administered questionnaire was used for data collection. Data were collected on social status (example, level of education, employment, and income), associated risk factors (example, smoking and alcohol consumption, contact history, narcotic drug use) and lifestyle changes during treatment (example, employment status, social interactions). The analysis included a logistic regression model to explore the association between social status and risk factors. Results: The total number of patients included in the study was 425. Tuberculosis was found to be strongly prevalentamong participants from the lower socio-economic status. It was also common in participants with a low level of education, unemployed, if employed, those who are engaged in unskilled employment and have low levels of income. Risk factors associated with the patients were smoking, alcohol consumptions, narcotic drug use, imprisonment, closecontact history with active TB patients and chronic medical conditions. Changes in employment and the reduction ofsocial-interactions were the main lifestyle changes of the participants occurred during the treatment period. The analysis also showed positive correlation between low-level social status and sputum smear infectivity, and use of dangerous drugs. Even after adjusting for confounders, tuberculosis negatively affected social interactions and income levels of participants from the low social status. Conclusion: Low socio-economic status negatively affected the lifestyle and social interactions of patients during the treatment period. Though competent treatment programs exist in Sri Lanka, it is still important to identify and mitigate risk factors associated with tuberculosis patients. A comprehensive multi-disciplinary approach considering patient lifestyle, and the implications of the disease and treatment on social interactions may strengthen the current preventive strategies.

Background: Fiscal policy targeting tobacco control is identified as the most effective strategy for rapid control of tobacco use. An optimum fiscal policy to estimate the percentage taxation that will maximise the government tax revenue, social savings and the net monetary benefit has not been empirically designed before in Sri Lanka. Methods: A model was developed using Microsoft Excel 2016, utilizing up-to-date published evidence on the cigarette sales, current fiscal policy, social cost of tobacco use, consumer response and the price elasticity of cigarettes. Univariate estimates on the expected revenue from tobacco tax, average annual social savings and the net monetary benefit were predicted for different levels of tobacco taxation. A deterministic sensitivity analysis was performed covering all possibilities. The percentage taxation maximizing the government tax revenue and the net monetary benefit were identified. Results: It was estimated that a further 30% tax increase from the 2019 baseline will generate approximately LKR 3544 million per year of additional tax revenue for the government while saving LKR 28 069 million per annum as social savings. A fiscal elevation of 50% will produce identical annual tax revenue to that of 2018, while securing a social saving of more than LKR 47 600 million per annum. The maximum net monetary benefit is achievable at an overnight tax increase of 90% from the baseline, however with a short-term compromise in tax revenue. Conclusion: The well-defined thresholds take tobacco taxation advocacy in Sri Lanka a step forward and will assist the government in taking an informed decision on its fiscal policy for cigarettes.

Introduction: Depression is a leading cause of human disability. Telemedicine-based interventions using text messaging are currently being trialled for the management of community-based clients with clinical depression. However, little is known about the effectiveness of such methods. Methods: We searched the databases PubMed, Embase, Informit, Cochrane Central Register of Controlled Trials, PsycINFO and Scopus for randomised controlled trials (RCTs) published between January 2000 and April 2019. Studies comparing text messaging interventions to a comparator group for patients with depression were included in the review. Articles were assessed for quality using the Joanna Briggs Institute critical appraisal checklist for RCTs. Results: Nine RCTs (945 patients: 764 adults and 181 adolescents) were included in the systematic review. Five studies used text messaging as the only intervention, whilst the remaining combined text messaging with other treatment modalities such as behavioural activation or cognitive behavioural therapy. A meta-analysis was conducted on seven selected RCTs (845 patients: 664 adults and 181 adolescents). The standardised mean reduction in depression due to text messaging interventions was 0.23 (95% confidence interval: –0.02 to 0.48). There was evidence of heterogeneity in treatment effect between studies. Discussion: There is marginal evidence supporting text messaging interventions as an effective treatment modality for people living with clinical depression. However, further research is needed to determine how best to utilise text-message interventions alongside other conventional forms of health services delivery.

The access healthcare services to inmates within correctional settings has generally been low and problematic due to specific nature of the prison setting. Telemedicine has been used as an alternative delivery mode. This study aimed to collate the current evidence related to the use of telemedicine to deliver health services within correctional settings. A comprehensive search of seven databases – PubMed, Embase, CINAHL, Informit, Cochrane Central Register of Controlled Trials, PsycINFO and Scopus, for peer-reviewed publications was conducted in April, 2018. Initial search identified 1147 articles. After review of the title and abstract, 36 articles were included in the final review. Of the included articles, 19 (53%) were published during the period of 2010-2018. Articles were predominantly from the USA (n = 23; 64 %), France and Australia. There were 23 descriptive studies (64%), five costing studies (14%) five experimental studies (14%), two mixed methods (6%) and one qualitative study (3%). The experimental studies were predominantly focused on mental health services (n = 4, 80%). The commonest telemedicine intervention used was synchronous videoconferencing (n = 21, 58%), while eight articles (22%) described asynchronous interventions. Telemedicine interventions were mainly used for mental health (n = 13), and ophthalmology (n = 4) disciplines. In the right circumstances, telemedicine interventions within correctional settings seem to be a useful method in connecting inmates with essential health services.