Accuracy of Oscillometry in diagnosing COPD
Dr Deesha Ghorpade PhD1, Sujata Chauthmal MSc3, Ruby Swami MSc3, Dr Sundeep Salvi MD, PhD1,2,3
1. Pulmocare Research and Education Foundation, Pune, India
2. Symbiosis Medical College for Women and Symbiosis University Hospital and Research Centre, Symbiosis International (Deemed University), Pune, India
3. Chest Research and Training Pvt Ltd, Pune, India
Letter correspondence with reference to article published in the BMJ Open Research:
Gao L, Wang H, Wu Y, Wang T, Xiong S, Qiu R, Zhou H, Liu L, Jia H, Qin J, Xu D, Shen Y, Chen L, Wen FQ. Diagnostic value of impulse oscillometry in chronic obstructive pulmonary disease: a multicentre, retrospective, observational study. BMJ Open. 2024 Oct 8;14(10):e087687. doi: 10.1136/bmjopen-2024-087687. PMID: 39384230.
Address for correspondence:
Dr Sundeep Salvi MD, PhD(UK), Hon FRCP(London)
Director
Pulmocare Research and Education (PURE) Foundation
Pune 411014
INDIA:
We read with great interest the article by Gao et al (1), where the authors investigated the effectiveness of impulse oscillometry (IOS) for the diagnosis of COPD by comparing it with spirometry in a population of 6,307 patients, including 2,109 COPD patients diagnosed on spirometry and 4,198 non-COPD subjects visiting respiratory clinics in 5 centers across China....
Accuracy of Oscillometry in diagnosing COPD
Dr Deesha Ghorpade PhD1, Sujata Chauthmal MSc3, Ruby Swami MSc3, Dr Sundeep Salvi MD, PhD1,2,3
1. Pulmocare Research and Education Foundation, Pune, India
2. Symbiosis Medical College for Women and Symbiosis University Hospital and Research Centre, Symbiosis International (Deemed University), Pune, India
3. Chest Research and Training Pvt Ltd, Pune, India
Letter correspondence with reference to article published in the BMJ Open Research:
Gao L, Wang H, Wu Y, Wang T, Xiong S, Qiu R, Zhou H, Liu L, Jia H, Qin J, Xu D, Shen Y, Chen L, Wen FQ. Diagnostic value of impulse oscillometry in chronic obstructive pulmonary disease: a multicentre, retrospective, observational study. BMJ Open. 2024 Oct 8;14(10):e087687. doi: 10.1136/bmjopen-2024-087687. PMID: 39384230.
Address for correspondence:
Dr Sundeep Salvi MD, PhD(UK), Hon FRCP(London)
Director
Pulmocare Research and Education (PURE) Foundation
Pune 411014
INDIA:
We read with great interest the article by Gao et al (1), where the authors investigated the effectiveness of impulse oscillometry (IOS) for the diagnosis of COPD by comparing it with spirometry in a population of 6,307 patients, including 2,109 COPD patients diagnosed on spirometry and 4,198 non-COPD subjects visiting respiratory clinics in 5 centers across China. The authors concluded that IOS parameters, while showing good correlation with spirometry indices in patients with COPD, did not perfectly substitute for spirometry in the diagnosis of COPD. We would like to disagree with the conclusion made by the authors and suggest that IOS may be at least as good as spirometry in the diagnosis of COPD, if not better.
The authors compared spirometry diagnosed COPD (post-bronchodilator FEV1/FVC < 0.70) patients in a clinic setting versus patients visiting the respiratory clinic but not having COPD. In an ideal setting, the control population should have been healthy subjects with no respiratory symptoms and normal spirometry to evaluate the accuracy of oscillometry for COPD diagnosis. Rather, the authors chose to compare COPD patients with those visiting the respiratory clinic presumably for presence of respiratory symptoms (not mentioned in the manuscript). More than likely, these included smokers, asthmatic patients, patients with non-obstructive chronic bronchitis and pre-COPD subjects in the non-COPD group, all of whom would have normal spirometry. Additionally, patients with bronchiectasis and post pulmonary TB lung diseases were not excluded. We suspect that these subjects would have occupied a significant proportion of the non-COPD group. All these patients would show abnormal oscillometry indices in the same direction as COPD. 60% of smokers with normal spirometry have been shown to have some abnormality on oscillometry (2). These ‘confounding patients’ would significantly reduce the sensitivity, specificity and the accuracy of oscillometry in the diagnosis of COPD.
There is no consensus on how to interpret Oscillometry indices. Earlier recommendation was to compare measured values with predicted values, and if the measured values were >50% of predicted, it was generally considered to be abnormal. Later, Z-scores were recommended for interpretation using the same thought process as for Spirometry (Z-scores > or < 1.64 to be considered abnormal) (3). There are, however, 2 major concerns with this approach (i) Unlike spirometry, oscillometry indices are not normally distributed, and therefore using % predicted or Z-scores may give flawed interpretation (4), (ii) unlike spirometry indices, which are critically related to gender, age height, weight and ethnicity, oscillometry indices seem to be related only to height (5).
There is now a growing recognition that fixed cut-off values for different oscillometry indices should be used instead of percent predicted or Z-scores. In concordance with this belief, Gao et al in their analysis have show fixed cut off values rather than % predicted or Z-scores. But they compare the mean values of oscillometry indices between COPD and non-COPD subjects, which does not seem to be appropriate, as these values are not normally distributed. Using the Indian Antlia FOT device, we reported cut off values for different oscillometry indices to differentiate between healthy and obstructive airways disease, viz: R5 >4 cmH2O/L/s, R5-R20 >1 cmH2O/L/s, X5 <-1 cmH2O/L/s and Fres >12 Hz (6). When we plotted the 95% confidence interval values for R5, R5-R20, X5 and Fres values of COPD and non COPD subjects in the study by Gao et al, the non-COPD subjects showed significantly higher values than what we would have expected , and we believe this is because the non-COPD subjects included smokers, asthmatics, pre COPD and non-obstructive chronic bronchitis patients, all of whom would show values closer to COPD indices on oscillometry, thereby reducing sensitivity and specificity of oscillometry.
Despite the inclusion of these ‘confounding subjects’ in the non-COPD arm, IOS seems to have shown reasonably good sensitivity, specificity and accuracy (64%, 80% and 78% respectively) in picking up COPD. Had these non-COPD subjects been excluded, the sensitivity would have gone much higher. Moreover, the authors report accuracy of around 75% to differentiate between different severities of COPD, which is as good as it can get. Together, these observations suggest that their conclusion that oscillometry did not perfectly substitute for spirometry in the diagnosis of COPD is not appropriate.
References:
1. Gao L, Wang H, Wu Y, Wang T, Xiong S, Qiu R, Zhou H, Liu L, Jia H, Qin J, Xu D, Shen Y, Chen L, Wen FQ. Diagnostic value of impulse oscillometry in chronic obstructive pulmonary disease: a multicentre, retrospective, observational study. BMJ Open. 2024 Oct 8;14(10):e087687.
2. Kaminsky DA, Simpson SJ, Berger KI, Calverley P, de Melo PL, Dandurand R, Dellacà RL, Farah CS, Farré R, Hall GL, Ioan I, Irvin CG, Kaczka DW, King GG, Kurosawa H, Lombardi E, Maksym GN, Marchal F, Oostveen E, Oppenheimer BW, Robinson PD, van den Berge M, Thamrin C. Clinical significance and applications of oscillometry. Eur Respir Rev. 2022 Feb 9;31(163):210208.
3. Liang X, Zheng J, Gao Y, Zhang Z, Han W, Du J, Lu Y, Chen L, Wang T, Liu J, Huang G, Zhao B, Zhao G, Zhang X, Peng Y, Chen X, Zhou N. Clinical application of oscillometry in respiratory diseases: an impulse oscillometry registry. ERJ Open Res. 2022 Oct 17;8(4):00080-2022.
4. Salvi S, Ghorpade D. Z-Scores or Fixed Cutoff Values to Interpret Oscillometry: Opportunities from the LEAD Study. Am J Respir Crit Care Med. 2024 May 15;209(10):1281.
5. Ghorpade D, Chauthmal S, Swami R, Salvi S. Height seems to be the only variable that determines lung oscillometry indices. ERJ Open Res. 2024 Jul 8;10(4):00106-2024.
6. Salvi S, Ghorpade D, Vanjare N, Madas S, Agrawal A. Interpreting lung oscillometry results: Z-scores or fixed cut-off values? ERJ Open Res. 2023 Mar 27;9(2):00656-2022.
Dear Editor,
I would like to congratulate Hérold et al. for the significant achievement in their work, titled “You grow with the allergy: A grounded theory study of families’ experiences with food allergy risk or diagnosis in early childhood,” recently published in BMJ Open'. The article is rather helpful in understanding the multifaceted path which families have to follow during the life of a young child with food allergies, with particular focus on health capabilities of the family. The grounded theory and the emphasis on negotiation as a coping strategy are a promising angle, providing a basis for future solutions.
While the work indeed is an achievement in understanding this important topic, there are still gaps in the findings that deserve more attention in order to make the findings inclusive and generalizable.
Methodological Considerations
In the research, most of the mothers (25 out of 28 participants) were highlighted, very few fathers were sampled, and same-sex parents or other family members assuming the caregiving role were excluded."Most coparenting research considers the mother the primary carer (and thus the representative parent in the family), because mothers typically spend more time with children than do fathers. However, the exclusion of fathers from coparenting research on this basis contradicts evidence that the quality of the parent-child relationship is more important than the quantity of...
Dear Editor,
I would like to congratulate Hérold et al. for the significant achievement in their work, titled “You grow with the allergy: A grounded theory study of families’ experiences with food allergy risk or diagnosis in early childhood,” recently published in BMJ Open'. The article is rather helpful in understanding the multifaceted path which families have to follow during the life of a young child with food allergies, with particular focus on health capabilities of the family. The grounded theory and the emphasis on negotiation as a coping strategy are a promising angle, providing a basis for future solutions.
While the work indeed is an achievement in understanding this important topic, there are still gaps in the findings that deserve more attention in order to make the findings inclusive and generalizable.
Methodological Considerations
In the research, most of the mothers (25 out of 28 participants) were highlighted, very few fathers were sampled, and same-sex parents or other family members assuming the caregiving role were excluded."Most coparenting research considers the mother the primary carer (and thus the representative parent in the family), because mothers typically spend more time with children than do fathers. However, the exclusion of fathers from coparenting research on this basis contradicts evidence that the quality of the parent-child relationship is more important than the quantity of parental involvement."1. Such gender imbalance may tend to reinforce traditional roles of parents and negate the existence of different caregiving structures. Alternatively, low-income as well as immigrant subjects were also not represented adequately within the study, thus limiting the study reality in terms of the range of challenges and coping mechanisms employed.
Moving forward, embracing more comprehensive sampling in terms of cultural, social, and caregiving selection would enrich the understanding of how different structures and cultures are related to allergy control strategies.
Psychological Dimensions
The impact of allergies on psychosocial wellbeing is very briefly mentioned in this study, but it does not touch on the rare challenges that parents endure, such as anxiety, stress, or isolation."Emotional distress in parents of allergic children correlates with a diminished quality of life for both the child and the family, underscoring the need for mental health support." 2. These psychological dimensions are rather important considering the fact that an allergy attack is not only unpredictable but can also be fatal. In addition, the article neglects to consider the effect of this problem on the child even at the initial stages of development, and hencefew studies determine the likely influences in patterns of coping and family structure over years.
I do believe the authors would benefit from systematic research that examines the psychological state of the carers and the children over the years. These studies would also include programmes aimed at educating carers on such programmes as support groups or counselling services that are rarely implemented but are very effective.
In conclusion, I commend the authors for their innovative and impactful study, which has opened doors to a deeper understanding of families' struggles with childhood food allergies. By addressing these gaps, future research can further refine our understanding and create actionable solutions that benefit diverse populations.
While examining hospital preference, this exercise focuses on the hospital attributes and the features relating to the client provider interface. The set of opinions are again obtained in a scaled version of rating that has its own internal biases and consistency issues in reporting. Given the genuineness of this exploration based on an anonymous process of data collection, one is certain about the absence of non-sampling error. However, findings of such exploration misses out on a crucial segment that shapes hospital choice. More than outcomes, trust and other positive expectation, hospital choices are conditioned by the instance of the ailment being chronic or acute. The acute ailment does not offer greater freedom of choice given its instant nature of intervention whereas the chronic ailment offers a window of evaluation to make an appropriate choice backed by all known criterion. In this regard the findings of this exercise overlooks a crucial dimension that shapes choice/preference of hospitals.
As a Bhopal Disaster researcher and writer, the findings of health and social effects in areas beyond the city is not surprising. The 1984 disaster was a shock to the system which impacted the medical and social services all over the state. Coping with a disaster of this scale was unheard of anywhere in the world, and there was widespread admiration for those who responded, often risking their own lives in the process.(1)
I would like to add a few thoughts on my experiences relevant to these new findings:
1. Regarding the increased reporting of cancer in males, it is worth noting that the carcinogenic potency of methyl isocyanate is weak and it is not classified as a carcinogen.(2) In-utero chemical carcinogenesis is more likely to be associated with a longer-term exposure (e.g. diethystibestrol, DDT) rather than a single and short exposure as was the case in Bhopal.
2. The 1985 cohort was sensitized to their victim status so a possible over-reporting or disaster attribution of conditions may have occurred, sometimes enhanced by compensation expectations. Though much of the compensation (relatively meager and diluted by uninjured person claims) may have been settled by the time of the interviews, there are continuing demands to this day. Such overreporting and misattribution has been reported in our 1992 study and other disasters too, perhaps due to stress, fear, and distrust of official statements which may have led to an increase in felt or reported sy...
As a Bhopal Disaster researcher and writer, the findings of health and social effects in areas beyond the city is not surprising. The 1984 disaster was a shock to the system which impacted the medical and social services all over the state. Coping with a disaster of this scale was unheard of anywhere in the world, and there was widespread admiration for those who responded, often risking their own lives in the process.(1)
I would like to add a few thoughts on my experiences relevant to these new findings:
1. Regarding the increased reporting of cancer in males, it is worth noting that the carcinogenic potency of methyl isocyanate is weak and it is not classified as a carcinogen.(2) In-utero chemical carcinogenesis is more likely to be associated with a longer-term exposure (e.g. diethystibestrol, DDT) rather than a single and short exposure as was the case in Bhopal.
2. The 1985 cohort was sensitized to their victim status so a possible over-reporting or disaster attribution of conditions may have occurred, sometimes enhanced by compensation expectations. Though much of the compensation (relatively meager and diluted by uninjured person claims) may have been settled by the time of the interviews, there are continuing demands to this day. Such overreporting and misattribution has been reported in our 1992 study and other disasters too, perhaps due to stress, fear, and distrust of official statements which may have led to an increase in felt or reported symptoms.(3,4) These conditions were certainly prevalent in Bhopal even 10 years after the event, and may well have played a role in symptom reporting.
2. Conversely, some women who were labeled as ‘gas-affected’ and had trouble getting married, may have sought to hide their status, particularly if they migrated after receiving compensation.
3. Many of the Bhopal studies suffer from incorrect exposure assignment, thus resulting in misclassification.(4) An example is the ICMR groundwater contamination study where distance of residence from the Carbide plant was used instead of proximity and water usage from contaminated wells. (5)
4. No MIC exposure or effect biomarkers have yet been found in the exposed population. However, environmental dispersion modeling of the gas cloud may be able to throw light on whether the new findings of health and social effects are due to direct exposure of the population to the gas cloud. Retrospective information, if available, on damage to trees and vegetation in the expanded area may assist in this process. Given that almost 40 years have passed, there will be scientific uncertainties. Better late than never, though, for the world’s worst industrial disaster.
1.(https://en.wikipedia.org/wiki/International_Medical_Commission_on_Bhopal).
2.Senthilkumar CS, Sah NK, Ganesh N. Methyl isocyanate and carcinogenesis: bridgeable gaps in scientific knowledge. Asian Pac J Cancer Prev. 2012;13(6):2429-35. doi: 10.7314/apjcp.2012.13.6.2429. PMID: 22938400.
3. Cullinan P, Acquilla SD, Dhara VR. Long term morbidity in survivors of the 1984 Bhopal gas leak. Natl Med J India. 1996 Jan-Feb;9(1):5-10. PMID: 8713516.
4. Helfenstein U, Ackermann-Liebrich U, Braun-Fahrländer C, Wanner HU. The environmental accident at 'Schweizerhalle' and respiratory diseases in children: a time series analysis. Stat Med. 1991 Oct;10(10):1481-92. doi: 10.1002/sim.4780101002. PMID: 1947506.
5. Dhara VR. Investigating the Medical Aspects of the World's Worst Industrial Disaster. New Solut. 2023 Nov;33(2-3):113-118. doi: 10.1177/10482911231190583. Epub 2023 Jul 25. Erratum in: New Solut. 2023 Sep 28:10482911231204307. doi: 10.1177/10482911231204307. PMID: 37491865.
6. Banerjee N, Banerjee A, Sabde Y, Tiwari RR, Prakash A. Morbidity profile of communities in Bhopal city (India) vis-à-vis distance of residence from Union Carbide India Limited plant and drinking water usage pattern. J Postgrad Med. 2020 Apr-Jun;66(2):73-80. doi: 10.4103/jpgm.JPGM_391_19. PMID: 32167062; PMCID: PMC7239398.
Khalifeh et al. conducted a meta-analysis to evaluate the risk reduction of head and neck (HN) cancer following smoking cessation (1). The authors analyzed data from 65 studies, which had been published until June 2022. They were composed of 5 cohort and 60 case-control studies. Relative risks (RRs) (95% confidence intervals [CIs]) of former smokers compared with current smokers for HN cancer was 0.40 (0.35 to 0.46). By using 37 studies, RR (95% CI) per 10-year increase in smoking cessation was 0.47 (0.43 to 0.52). I present information from a prospective study, which presents a mortality risk.
Lee et al. reported the association between the duration of abstinence, overall and HN-specific mortality (2). Former smokers presented a significant risk reduction in HN-specific mortality, but there was no significant difference in the risk of noncancer mortality. Compared with current smokers, former smokers who quit >10 years before diagnosis presented the adjusted hazard ratios (95% CIs) of 0.72 (0.56 to 0.93) and 0.64 (0.46 to 0.91) for overall and HN-specific mortality. They emphasized that long-term abstinence over 10 years had a significant risk reduction in overall and HN-specific mortality. Although heterogeneity in each group of a meta-analysis was extremely high, risk assessment with incidence/prevalence may have some difficulties of data collections. Lee et al. conducted sensitivity analyses by the types of treatment, and radiation therapy only showed a signi...
Khalifeh et al. conducted a meta-analysis to evaluate the risk reduction of head and neck (HN) cancer following smoking cessation (1). The authors analyzed data from 65 studies, which had been published until June 2022. They were composed of 5 cohort and 60 case-control studies. Relative risks (RRs) (95% confidence intervals [CIs]) of former smokers compared with current smokers for HN cancer was 0.40 (0.35 to 0.46). By using 37 studies, RR (95% CI) per 10-year increase in smoking cessation was 0.47 (0.43 to 0.52). I present information from a prospective study, which presents a mortality risk.
Lee et al. reported the association between the duration of abstinence, overall and HN-specific mortality (2). Former smokers presented a significant risk reduction in HN-specific mortality, but there was no significant difference in the risk of noncancer mortality. Compared with current smokers, former smokers who quit >10 years before diagnosis presented the adjusted hazard ratios (95% CIs) of 0.72 (0.56 to 0.93) and 0.64 (0.46 to 0.91) for overall and HN-specific mortality. They emphasized that long-term abstinence over 10 years had a significant risk reduction in overall and HN-specific mortality. Although heterogeneity in each group of a meta-analysis was extremely high, risk assessment with incidence/prevalence may have some difficulties of data collections. Lee et al. conducted sensitivity analyses by the types of treatment, and radiation therapy only showed a significant risk reduction in mortality by smoking cessation and long-term quitting. Many factors might interact with prognosis, and caution should be paid to clinical outcomes in mortality study.
References
1. Khalifeh M, Ginex P, Boffetta P. Reduction of head and neck cancer risk following smoking cessation: a systematic review and meta-analysis. BMJ Open 2024;14(8):e074723.
2. Lee JJW, Kunaratnam V, Kim CJH, et al. Cigarette smoking cessation, duration of smoking abstinence, and head and neck squamous cell carcinoma prognosis. Cancer 2023;129(6):867-77.
Dear Editor,
I am writing in response to the article, “Association between sleep quality and uncertainty stress among healthcare professionals in hospitals in China,” recently published in BMJ Open. The study reveals the high prevalence of insomnia and uncertainty stress among healthcare workers, which is an important contribution. Furthermore, the use of validated tools such as the Athens Insomnia Scale (AIS) enhances the reliability of the findings, offering solid evidence for the urgent need to address healthcare workers’ mental well-being.
However, I would like to offer some additional suggestions that could make a further discussion.
Firstly, regional and hospital-level differences are important factors that cannot be overlooked. The study covers only three provinces, yet healthcare resources within these provinces vary significantly, which introduces potential variability in stress sources. For instance, tertiary hospitals in major cities, such as Hangzhou in Zhejiang province, often experience high levels of stress due to large patient volumes and complex cases. In contrast, healthcare professionals in less resourced areas, such as Lishui in Zhejiang province, are facing chronic stress from staff shortages and inadequate infrastructure. Understanding these regional disparities can provide a more detailed view of how healthcare environments influence sleep quality.
Secondly, the timing of data collection also affects the study’s findings. T...
Dear Editor,
I am writing in response to the article, “Association between sleep quality and uncertainty stress among healthcare professionals in hospitals in China,” recently published in BMJ Open. The study reveals the high prevalence of insomnia and uncertainty stress among healthcare workers, which is an important contribution. Furthermore, the use of validated tools such as the Athens Insomnia Scale (AIS) enhances the reliability of the findings, offering solid evidence for the urgent need to address healthcare workers’ mental well-being.
However, I would like to offer some additional suggestions that could make a further discussion.
Firstly, regional and hospital-level differences are important factors that cannot be overlooked. The study covers only three provinces, yet healthcare resources within these provinces vary significantly, which introduces potential variability in stress sources. For instance, tertiary hospitals in major cities, such as Hangzhou in Zhejiang province, often experience high levels of stress due to large patient volumes and complex cases. In contrast, healthcare professionals in less resourced areas, such as Lishui in Zhejiang province, are facing chronic stress from staff shortages and inadequate infrastructure. Understanding these regional disparities can provide a more detailed view of how healthcare environments influence sleep quality.
Secondly, the timing of data collection also affects the study’s findings. The cross-sectional design captures data from a single point in time, limiting the study’s ability to account for seasonal workload fluctuations. Besides the covid-19 pandemic mentioned in the text, Temporal variations, such as increased patient admissions during specific seasons (e.g., flu season), can significantly influence healthcare providers' stress levels and sleep patterns (Arnedt, J. T., et al, 2005). Longitudinal data is essential to capture these seasonal trends accurately.
Lastly, the voluntary participation method introduces potential selection bias. Healthcare workers experiencing the highest levels of stress or fatigue may have been less likely to participate, skewing the results towards those with milder stress and better sleep patterns. This issue may be particularly pronounced during periods of increased hospital admissions, further complicating the study's findings.
In conclusion, the study offers very valuable insights, but future research should consider expanding the sample across more regions, employing longitudinal designs, and accounting for hospital-level disparities. These approaches would provide a deeper understanding of the complexities influencing healthcare workers’ well-being and guide more targeted interventions.
Reference:
Arnedt, J. T., Owens, J., Crouch, M., Stahl, J., & Carskadon, M. A. (2005). Neurobehavioral. Performance of Residents after Heavy Night Call vs after Alcohol Ingestion. JAMA, 294(9), 1025-1033. doi:10.1001/jama.294.9.1025
The initial mixed methods study as described in this published protocol (Hansen et al., 2021) had two components: a prospective quantitative and qualitative study. Since publication of this protocol, two changes were made from the described study design which occurred as a result of low recruitment in the prospective studies, and challenges related to accessing the study site for data collection throughout the COVID-19 pandemic due to Government enforced ‘lockdowns’. The ‘lockdowns prevented all non-essential access to the hospital and as a consequence further recruitment to the study was not possible. This rapid response outlines the required key changes to the study design, approved by the University of Newcastle Human Research Ethics Committee and the participating organisation.
The first change to the protocol involved the inclusion of a retrospective quantitative study which commenced on August 2, 2022. A file audit was conducted which included all women admitted to the study site between 01/01/2016 and 30/04/2021. These dates were chosen to allow the collection of five years of data preceding the commencement of the prospective study. Inclusion criteria included all women admitted to the study site during the study timeframe comprising women who did and who did not experience seclusion during their admission. Following ethical approval, a de-identified electronic list of women admitted during the study timeframe was provided to the first author from the study...
The initial mixed methods study as described in this published protocol (Hansen et al., 2021) had two components: a prospective quantitative and qualitative study. Since publication of this protocol, two changes were made from the described study design which occurred as a result of low recruitment in the prospective studies, and challenges related to accessing the study site for data collection throughout the COVID-19 pandemic due to Government enforced ‘lockdowns’. The ‘lockdowns prevented all non-essential access to the hospital and as a consequence further recruitment to the study was not possible. This rapid response outlines the required key changes to the study design, approved by the University of Newcastle Human Research Ethics Committee and the participating organisation.
The first change to the protocol involved the inclusion of a retrospective quantitative study which commenced on August 2, 2022. A file audit was conducted which included all women admitted to the study site between 01/01/2016 and 30/04/2021. These dates were chosen to allow the collection of five years of data preceding the commencement of the prospective study. Inclusion criteria included all women admitted to the study site during the study timeframe comprising women who did and who did not experience seclusion during their admission. Following ethical approval, a de-identified electronic list of women admitted during the study timeframe was provided to the first author from the study site’s Chief Health Information Manager. The electronic list contained the medical record number of women admitted, date of admission and date of birth. Data were collected on site by AH, using the medical record number. Data which included demographic and clinical information were collected from the women’s medical record and entered directly into Research Electronic Data Capture (REDCap) (Harris et al., 2019; Harris et al., 2009); as per the prospective study reported in this published protocol (Hansen et al., 2021). Where the woman experienced seclusion, data pertaining to the seclusion event (as described in the published protocol) were collected. Data storage and analysis are unchanged and accurate as reported in the published protocol (Hansen et al., 2021).
The second change to the study design relates to the low recruitment specifically in the qualitative component of the prospective study. This resulted in the pragmatic decision to present findings as a single case study, combining both the quantitative and qualitative data of the prospective study due to one person consenting to participate in an interview. The inclusion of the single case study supports a deep understanding of the case and the phenomenon of interest (Yin, 2018). In this single case the characteristics and experience of seclusion for a woman in a secure forensic hospital were analysed. Data collected for the single case study were the same as described in the published protocol (Hansen et al., 2021). The quantitative and qualitative data collected for the single case were linked and integrated for analysis, which enhanced the understanding of the woman’s experiences.
References
Hansen, A. C., Hazelton, M., Rosina, R., & Inder, K. J. (2021). Exploring the frequency, duration and experience of seclusion for women in a forensic mental health setting: a mixed-methods study protocol. BMJ Open, 11, e044261. https://doi.org/10.1136/bmjopen-2020-044261
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42(2):377-81.
Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 2019;95.
Yin, RK. Case study research and applications: Design and methods. Sixth edition. SAGE Publications, Inc.; 2018.
We recently read “Barriers and facilitators to use of digital health tools by healthcare practitioners and their patients, before and during the COVID-19 pandemic: a multimethods study,” which explores the critical question of how healthcare professionals adopt and use digital health technologies (DHTs).
The authors’ examination of barriers to DHT access and use on organisational and individual levels was a particularly valuable finding for their future implementation. We found the observation that some healthcare professionals (HCPs) acted as gatekeepers for patients’ access to DHTs particularly compelling. This highlights the importance of addressing biases and assumptions about the type of patients who could use and benefit from DHTs, to avoid unintentionally increasing digital health inequity. While this was not the primary focus of the study, we believe it is an important finding that should be further explored to understand how HCPs made such judgments and how they compare with patients’ perceptions. Understanding the underlying factors shaping professionals’ assumptions may provide a deeper understanding of the barriers to using digital tools. Additionally, it would have been interesting to further investigate usage patterns within the participants' geographic regions. The characteristics of these regions (e.g. socioeconomic status, demographics, digital access levels) may be associated with different adoption rates of DHTs by profe...
We recently read “Barriers and facilitators to use of digital health tools by healthcare practitioners and their patients, before and during the COVID-19 pandemic: a multimethods study,” which explores the critical question of how healthcare professionals adopt and use digital health technologies (DHTs).
The authors’ examination of barriers to DHT access and use on organisational and individual levels was a particularly valuable finding for their future implementation. We found the observation that some healthcare professionals (HCPs) acted as gatekeepers for patients’ access to DHTs particularly compelling. This highlights the importance of addressing biases and assumptions about the type of patients who could use and benefit from DHTs, to avoid unintentionally increasing digital health inequity. While this was not the primary focus of the study, we believe it is an important finding that should be further explored to understand how HCPs made such judgments and how they compare with patients’ perceptions. Understanding the underlying factors shaping professionals’ assumptions may provide a deeper understanding of the barriers to using digital tools. Additionally, it would have been interesting to further investigate usage patterns within the participants' geographic regions. The characteristics of these regions (e.g. socioeconomic status, demographics, digital access levels) may be associated with different adoption rates of DHTs by professionals. Exploring these regional differences could provide valuable socioeconomic context to inform future implementation strategies and more equitable access to DHTs.
We believe the authors’ decision to conduct additional research to understand how barriers and facilitators may have shifted due to the COVID-19 pandemic strengthened the study. It also raised our curiosity about how these barriers and facilitators may have continued to change throughout the pandemic. Data collected from HCPs at the start of the pandemic (July-August 2020) might not provide the most up-to-date insight into the evolving role of these tools. The burden on healthcare services increased exponentially while DHTs and their implementation simultaneously improved in each subsequent lockdown [1,2]. Notably, while healthcare services had begun using digital tools before the pandemic, the change was generally slow. The pandemic accelerated this transformation in Scotland, where healthcare consultations rapidly shifted from face-to-face to videoconferencing, with video appointments increasing from 20,000 in mid-2020 to over 1 million in July 2021 [1]. Future research could build on this study to generate additional insights into how the pandemic has altered HCPs’ access to and use of DHTs now that the pandemic's peak has passed.
Some research has suggested that, from a patient perspective, elevated public interest levels in digital health during the Covid-19 pandemic were not sustained [3]. Potential reasons for this include digital infrastructure and competency issues [3] and barriers to systems integration and trust [4]. This highlights the importance of understanding how barriers for HCPs to access and uptake of DHTs intersect with barriers experienced by patients. This study highlights HCPs’ perspectives of patients’ barriers; future research could generate additional insights by exploring barriers from patients’ perspectives and identifying areas of alignment and misalignment. This will be a necessary step in training HCPs in the use of DHTs with patients in a way that does not increase health inequity and digital exclusion.
References
1 Fang ML, Walker M, Wong KLY, et al. Future of digital health and community care: Exploring intended positive impacts and unintended negative consequences of COVID-19. Healthc Manage Forum. 2022;35:279–85. doi: 10.1177/08404704221107362
2 Newman KL, Jeve Y, Majumder P. Experiences and emotional strain of NHS frontline workers during the peak of the COVID-19 pandemic. Int J Soc Psychiatry. 2022;68:783–90. doi: 10.1177/00207640211006153
3 van Kessel R, Kyriopoulos I, Wong BLH, et al. The effect of the COVID-19 pandemic on digital health-seeking behavior: Big data interrupted time-series analysis of Google Trends. J Med Internet Res. 2023;25:e42401. doi: 10.2196/42401
4 Peek N, Sujan M, Scott P. Digital health and care: emerging from pandemic times. BMJ Health Care Inform. 2023;30:e100861. doi: 10.1136/bmjhci-2023-100861
We have read the article by Murray et al interestingly, the article was engaging and thought provoking [1]. With the advancements of digitalization technology in the health sector, diabetes care and management have also experienced modifications and betterment. Various newer technologies cater to individual conditions & needs and provide personalized treatment. Device-based technologies such as continuous glucose monitoring (CGM) linked to closed-loop insulin delivery systems, insulin pumps, and wearable devices linked with mobile apps have made the self-management of diabetes possible regularly. The web assisted interventions can be an asset for diabetes management in a developing country like India where the number of people with diabetes are currently is around 40.9 million and is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken [2]. The prevalence in the recent report by the Indian Council of Medical Research- India Diabetes (ICMR-INDIAB) study was observed to be 11.4% [3]. The scenario in the tribal population of India is more or less similar as the diabetes prevalence in tribal areas was observed to be from 0.7-10.1% [4] which is an alarming figure, but still, a systematic tribe-wise prevalence data is meager. Also, land alienation, lack of health management infrastructure, low connectivity, and technological challenges add up to their condition. While various technologies are challenging to implement due to electricity, network...
We have read the article by Murray et al interestingly, the article was engaging and thought provoking [1]. With the advancements of digitalization technology in the health sector, diabetes care and management have also experienced modifications and betterment. Various newer technologies cater to individual conditions & needs and provide personalized treatment. Device-based technologies such as continuous glucose monitoring (CGM) linked to closed-loop insulin delivery systems, insulin pumps, and wearable devices linked with mobile apps have made the self-management of diabetes possible regularly. The web assisted interventions can be an asset for diabetes management in a developing country like India where the number of people with diabetes are currently is around 40.9 million and is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken [2]. The prevalence in the recent report by the Indian Council of Medical Research- India Diabetes (ICMR-INDIAB) study was observed to be 11.4% [3]. The scenario in the tribal population of India is more or less similar as the diabetes prevalence in tribal areas was observed to be from 0.7-10.1% [4] which is an alarming figure, but still, a systematic tribe-wise prevalence data is meager. Also, land alienation, lack of health management infrastructure, low connectivity, and technological challenges add up to their condition. While various technologies are challenging to implement due to electricity, network connectivity, infrastructure, and storage facilities, some technologies can be implemented easily with the joint approach of primary health care staff, governmental & non-governmental organizations, and people with diabetes themselves. The situation demands a tailored multifaceted approach for implementing the technological-based remedies in tribal settings of India as it will increase the quality of life in these areas.
The web-based interventions like virtual group assessment (VGA), clinical decision support system (CDSS) can hold promise in diabetes management in tribal setting, which can get the population access to health expert in the fields even after sitting in a remote location. Clinical decision support systems can become a vital tool for improving diabetes care in tribal settings as it uses data analytics and computational power to determine relevant patterns from patients' medication history and glycemic records [5]. Then create personalized prescription strategies for their individual needs. For VGA, the primary health care workers (Accredited Social Health Activist (ASHA), Anganwadi workers (AWW) of tribal settings can be provided with the computers or equivalent devices and with their help the concerned people can directly consult the expert health care groups [6]. As technology continues to advance the future of diabetes management is moving toward solutions that are user-centred and effective.
Implementing web-based interventions is challenging in tribal settings as it has language and cultural barriers, as technology may be unfamiliar or culturally mismatched, requiring extensive education and community engagement. It will be helpful if the interface could be designed in local languages. Ministry of Tribal Affairs, Government of India has also shown its concern about impowering the digitalization in tribal groups through Digital India scheme. [7] Also, training camps and awareness programs can be organised by the local health staff and administration to make the interface familiar to the population. Given these multifaceted challenges, a holistic and culturally sensitive approach, taking into account the unique needs and circumstances of tribal areas, is imperative to ensure the successful integration of web-based interventions in diabetes management.
1. Murray E, Sweeting M, Dack C, Pal K, Modrow K, Hudda M, Li J, Ross J, Alkhaldi G, Barnard M, Farmer A, Michie S, Yardley L, May C, Parrott S, Stevenson F, Knox M, Patterson D. Web-based self-management support for people with type 2 diabetes (HeLP-Diabetes): randomised controlled trial in English primary care. BMJ Open. 2017 Sep 27;7(9):e016009. doi: 10.1136/bmjopen-2017-016009.
2. Pradeepa, R., & Mohan, V. (2021). Epidemiology of type 2 diabetes in India. Indian Journal of Ophthalmology, 69(11), 2932-2938. doi: 10.4103/ijo.IJO_1627_21.
3. Anjana, R. M., Unnikrishnan, R., Deepa, M., Pradeepa, R., Tandon, N., Das, A. K., ... & Mohan, V. (2023). Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). The Lancet Diabetes & Endocrinology, 11(7), 474-489. doi: 10.1016/S2213-8587(23)00119-5.
4. Shriraam, V., Mahadevan, S., & Arumugam, P. (2021). Prevalence and Risk Factors of Diabetes, Hypertension, and Other Non-Communicable Diseases in a Tribal Population in South India. Indian Journal of Endocrinology and Metabolism, 25(4), 313-319. doi: 10.4103/ijem.ijem_298_21.
5. Singh K, Chakma T, Shrivastava S. Type 1 Diabetes Management Among Tribes: How Virtual Group Appointments Approach May Be Beneficial. J Diabetes Sci Technol. 2023 Jul;17(4):1121-1122. doi: 10.1177/19322968231170889.
6. Singh K, Chakma T, Nagwanshi A, Shrivastava S. Can the Clinical Decision Support System Untangle the Difficulties in the Diabetes Management of Indian Tribes? J Diabetes Sci Technol. 2024 Mar;18(2):526-527. doi: 10.1177/19322968231222488.
7. Kapoor, Naval & Maurya, Ashutosh & Raman, Raghu & Govind, Kumar & Nedungadi, Prema. (2021). Digital India eGovernance Initiative for Tribal Empowerment: Performance Dashboard of the Ministry of Tribal Affairs. 10.1007/978-981-16-0882-7_92.
The recent paper “Profiles of health literacy and digital health literacy in clusters of hospitalised patients: a single-centre, cross-sectional study” generates insights into the health literacy characteristics of patients. We commend the authors for their efforts to enhance health equity by examining the types of patients who may require additional health literacy support when hospitalised. The authors’ comprehensive analysis of both health literacy and digital health literacy offers a strong foundation for future research, particularly in enhancing health equity by identifying vulnerable populations in hospital settings. This rapid response aims to emphasise two key areas of the analysis where further elaboration could enhance the study's quality and insights: the potential influence of the study's context on the findings and the practical implications of the generated clusters.
Health literacy refers to an individual’s ability to maintain health through knowledge, self-management, and collaboration with health professionals [1]. The paper defines health and digital health literacy as involving “access, understanding, appraisal, and use” of health information. The measurement tools reflect this broad perspective. Data was collected from a single clinical setting, and while the authors note limited generalisability, more discussion on the influence of contextual factors would have been helpful. The field would benefit from further c...
The recent paper “Profiles of health literacy and digital health literacy in clusters of hospitalised patients: a single-centre, cross-sectional study” generates insights into the health literacy characteristics of patients. We commend the authors for their efforts to enhance health equity by examining the types of patients who may require additional health literacy support when hospitalised. The authors’ comprehensive analysis of both health literacy and digital health literacy offers a strong foundation for future research, particularly in enhancing health equity by identifying vulnerable populations in hospital settings. This rapid response aims to emphasise two key areas of the analysis where further elaboration could enhance the study's quality and insights: the potential influence of the study's context on the findings and the practical implications of the generated clusters.
Health literacy refers to an individual’s ability to maintain health through knowledge, self-management, and collaboration with health professionals [1]. The paper defines health and digital health literacy as involving “access, understanding, appraisal, and use” of health information. The measurement tools reflect this broad perspective. Data was collected from a single clinical setting, and while the authors note limited generalisability, more discussion on the influence of contextual factors would have been helpful. The field would benefit from further consideration of the social context of health decision-making and the communication skills of health professionals [2]. Profiling patients in a setting and circumstance likely to influence responses to the measurement tools employed directly suggests the authors’ broad agreement with this view. The paper could further build on its contribution by exploring health literacy as an enduring individual capacity and a more context-dependent and dynamic construct. Including a description of the digital infrastructure in the study’s setting could have provided valuable insights into how this context influenced the findings. This would offer implications for broader applications. The work lays a strong foundation for understanding health literacy, which future research can expand upon by incorporating these additional contextual factors.
The impact of the findings could be enhanced by improving the visualisation of the clusters and providing a more detailed explanation of their practical implications. Visual representations, such as radar charts and cluster plots, can facilitate more efficient interpretation of findings. The six clusters could also be labelled with memorable names to make them more accessible and easier to recall. The diverse health literacy and digital health literacy profiles of hospitalised patients highlight the need for tailored interventions. The practical application of the findings may be further strengthened by directly linking the profile of each cluster to interventions in healthcare settings. For instance, visual aids (e.g., picture-based education) are impactful for people with low health literacy [3–5]. In this case, the clusters with low health literacy and digital health literacy identified from this study might benefit from suggested tailored educational materials.
This study offers important insights into the health and digital literacy profiles of hospitalised patients, which emphasise the need for tailored interventions. Considering contextual factors like digital infrastructure could deepen understanding. Improving the visualisation of clusters and connecting them to practical healthcare interventions would enhance the findings. Building on the six clusters identified in this study, future research could expand on these clusters by creating predictive models to optimise resource allocation and improve patient care.
References
[1] Liu C, Wang D, Liu C, Jiang J, Wang X, Chen H, et al. What is the meaning of health literacy? A systematic review and qualitative synthesis. Fam Med Community Health 2020;8:e000351.
[2] McKenna VB, Sixsmith J, Barry MM. The relevance of context in understanding health literacy skills: Findings from a qualitative study. Health Expect 2017;20:1049–60.
[3] Sudore RL, Schillinger D. Interventions to improve care for patients with limited health literacy. J Clin Outcomes Manag 2009;16:20–9.
[4] Park J, Zuniga J. Effectiveness of using picture-based health education for people with low health literacy: An integrative review. Cogent Med 2016;3:1264679.
[5] Mbanda N, Dada S, Bastable K, Ingalill G-B, Ralf W S. A scoping review of the use of visual aids in health education materials for persons with low-literacy levels. Patient Educ Couns 2021;104:998–1017.
Accuracy of Oscillometry in diagnosing COPD
Dr Deesha Ghorpade PhD1, Sujata Chauthmal MSc3, Ruby Swami MSc3, Dr Sundeep Salvi MD, PhD1,2,3
1. Pulmocare Research and Education Foundation, Pune, India
2. Symbiosis Medical College for Women and Symbiosis University Hospital and Research Centre, Symbiosis International (Deemed University), Pune, India
3. Chest Research and Training Pvt Ltd, Pune, India
Letter correspondence with reference to article published in the BMJ Open Research:
Gao L, Wang H, Wu Y, Wang T, Xiong S, Qiu R, Zhou H, Liu L, Jia H, Qin J, Xu D, Shen Y, Chen L, Wen FQ. Diagnostic value of impulse oscillometry in chronic obstructive pulmonary disease: a multicentre, retrospective, observational study. BMJ Open. 2024 Oct 8;14(10):e087687. doi: 10.1136/bmjopen-2024-087687. PMID: 39384230.
Address for correspondence:
Dr Sundeep Salvi MD, PhD(UK), Hon FRCP(London)
Director
Pulmocare Research and Education (PURE) Foundation
Pune 411014
INDIA:
Email: sundeepsalvi@gmail.com
We read with great interest the article by Gao et al (1), where the authors investigated the effectiveness of impulse oscillometry (IOS) for the diagnosis of COPD by comparing it with spirometry in a population of 6,307 patients, including 2,109 COPD patients diagnosed on spirometry and 4,198 non-COPD subjects visiting respiratory clinics in 5 centers across China....
Show MoreLETTER TO EDITOR.
Dear Editor,
I would like to congratulate Hérold et al. for the significant achievement in their work, titled “You grow with the allergy: A grounded theory study of families’ experiences with food allergy risk or diagnosis in early childhood,” recently published in BMJ Open'. The article is rather helpful in understanding the multifaceted path which families have to follow during the life of a young child with food allergies, with particular focus on health capabilities of the family. The grounded theory and the emphasis on negotiation as a coping strategy are a promising angle, providing a basis for future solutions.
While the work indeed is an achievement in understanding this important topic, there are still gaps in the findings that deserve more attention in order to make the findings inclusive and generalizable.
Methodological Considerations
In the research, most of the mothers (25 out of 28 participants) were highlighted, very few fathers were sampled, and same-sex parents or other family members assuming the caregiving role were excluded."Most coparenting research considers the mother the primary carer (and thus the representative parent in the family), because mothers typically spend more time with children than do fathers. However, the exclusion of fathers from coparenting research on this basis contradicts evidence that the quality of the parent-child relationship is more important than the quantity of...
Show MoreWhile examining hospital preference, this exercise focuses on the hospital attributes and the features relating to the client provider interface. The set of opinions are again obtained in a scaled version of rating that has its own internal biases and consistency issues in reporting. Given the genuineness of this exploration based on an anonymous process of data collection, one is certain about the absence of non-sampling error. However, findings of such exploration misses out on a crucial segment that shapes hospital choice. More than outcomes, trust and other positive expectation, hospital choices are conditioned by the instance of the ailment being chronic or acute. The acute ailment does not offer greater freedom of choice given its instant nature of intervention whereas the chronic ailment offers a window of evaluation to make an appropriate choice backed by all known criterion. In this regard the findings of this exercise overlooks a crucial dimension that shapes choice/preference of hospitals.
As a Bhopal Disaster researcher and writer, the findings of health and social effects in areas beyond the city is not surprising. The 1984 disaster was a shock to the system which impacted the medical and social services all over the state. Coping with a disaster of this scale was unheard of anywhere in the world, and there was widespread admiration for those who responded, often risking their own lives in the process.(1)
Show MoreI would like to add a few thoughts on my experiences relevant to these new findings:
1. Regarding the increased reporting of cancer in males, it is worth noting that the carcinogenic potency of methyl isocyanate is weak and it is not classified as a carcinogen.(2) In-utero chemical carcinogenesis is more likely to be associated with a longer-term exposure (e.g. diethystibestrol, DDT) rather than a single and short exposure as was the case in Bhopal.
2. The 1985 cohort was sensitized to their victim status so a possible over-reporting or disaster attribution of conditions may have occurred, sometimes enhanced by compensation expectations. Though much of the compensation (relatively meager and diluted by uninjured person claims) may have been settled by the time of the interviews, there are continuing demands to this day. Such overreporting and misattribution has been reported in our 1992 study and other disasters too, perhaps due to stress, fear, and distrust of official statements which may have led to an increase in felt or reported sy...
Khalifeh et al. conducted a meta-analysis to evaluate the risk reduction of head and neck (HN) cancer following smoking cessation (1). The authors analyzed data from 65 studies, which had been published until June 2022. They were composed of 5 cohort and 60 case-control studies. Relative risks (RRs) (95% confidence intervals [CIs]) of former smokers compared with current smokers for HN cancer was 0.40 (0.35 to 0.46). By using 37 studies, RR (95% CI) per 10-year increase in smoking cessation was 0.47 (0.43 to 0.52). I present information from a prospective study, which presents a mortality risk.
Lee et al. reported the association between the duration of abstinence, overall and HN-specific mortality (2). Former smokers presented a significant risk reduction in HN-specific mortality, but there was no significant difference in the risk of noncancer mortality. Compared with current smokers, former smokers who quit >10 years before diagnosis presented the adjusted hazard ratios (95% CIs) of 0.72 (0.56 to 0.93) and 0.64 (0.46 to 0.91) for overall and HN-specific mortality. They emphasized that long-term abstinence over 10 years had a significant risk reduction in overall and HN-specific mortality. Although heterogeneity in each group of a meta-analysis was extremely high, risk assessment with incidence/prevalence may have some difficulties of data collections. Lee et al. conducted sensitivity analyses by the types of treatment, and radiation therapy only showed a signi...
Show MoreDear Editor,
I am writing in response to the article, “Association between sleep quality and uncertainty stress among healthcare professionals in hospitals in China,” recently published in BMJ Open. The study reveals the high prevalence of insomnia and uncertainty stress among healthcare workers, which is an important contribution. Furthermore, the use of validated tools such as the Athens Insomnia Scale (AIS) enhances the reliability of the findings, offering solid evidence for the urgent need to address healthcare workers’ mental well-being.
However, I would like to offer some additional suggestions that could make a further discussion.
Firstly, regional and hospital-level differences are important factors that cannot be overlooked. The study covers only three provinces, yet healthcare resources within these provinces vary significantly, which introduces potential variability in stress sources. For instance, tertiary hospitals in major cities, such as Hangzhou in Zhejiang province, often experience high levels of stress due to large patient volumes and complex cases. In contrast, healthcare professionals in less resourced areas, such as Lishui in Zhejiang province, are facing chronic stress from staff shortages and inadequate infrastructure. Understanding these regional disparities can provide a more detailed view of how healthcare environments influence sleep quality.
Secondly, the timing of data collection also affects the study’s findings. T...
Show MoreThe initial mixed methods study as described in this published protocol (Hansen et al., 2021) had two components: a prospective quantitative and qualitative study. Since publication of this protocol, two changes were made from the described study design which occurred as a result of low recruitment in the prospective studies, and challenges related to accessing the study site for data collection throughout the COVID-19 pandemic due to Government enforced ‘lockdowns’. The ‘lockdowns prevented all non-essential access to the hospital and as a consequence further recruitment to the study was not possible. This rapid response outlines the required key changes to the study design, approved by the University of Newcastle Human Research Ethics Committee and the participating organisation.
The first change to the protocol involved the inclusion of a retrospective quantitative study which commenced on August 2, 2022. A file audit was conducted which included all women admitted to the study site between 01/01/2016 and 30/04/2021. These dates were chosen to allow the collection of five years of data preceding the commencement of the prospective study. Inclusion criteria included all women admitted to the study site during the study timeframe comprising women who did and who did not experience seclusion during their admission. Following ethical approval, a de-identified electronic list of women admitted during the study timeframe was provided to the first author from the study...
Show MoreDear Editor,
We recently read “Barriers and facilitators to use of digital health tools by healthcare practitioners and their patients, before and during the COVID-19 pandemic: a multimethods study,” which explores the critical question of how healthcare professionals adopt and use digital health technologies (DHTs).
The authors’ examination of barriers to DHT access and use on organisational and individual levels was a particularly valuable finding for their future implementation. We found the observation that some healthcare professionals (HCPs) acted as gatekeepers for patients’ access to DHTs particularly compelling. This highlights the importance of addressing biases and assumptions about the type of patients who could use and benefit from DHTs, to avoid unintentionally increasing digital health inequity. While this was not the primary focus of the study, we believe it is an important finding that should be further explored to understand how HCPs made such judgments and how they compare with patients’ perceptions. Understanding the underlying factors shaping professionals’ assumptions may provide a deeper understanding of the barriers to using digital tools. Additionally, it would have been interesting to further investigate usage patterns within the participants' geographic regions. The characteristics of these regions (e.g. socioeconomic status, demographics, digital access levels) may be associated with different adoption rates of DHTs by profe...
Show MoreWe have read the article by Murray et al interestingly, the article was engaging and thought provoking [1]. With the advancements of digitalization technology in the health sector, diabetes care and management have also experienced modifications and betterment. Various newer technologies cater to individual conditions & needs and provide personalized treatment. Device-based technologies such as continuous glucose monitoring (CGM) linked to closed-loop insulin delivery systems, insulin pumps, and wearable devices linked with mobile apps have made the self-management of diabetes possible regularly. The web assisted interventions can be an asset for diabetes management in a developing country like India where the number of people with diabetes are currently is around 40.9 million and is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken [2]. The prevalence in the recent report by the Indian Council of Medical Research- India Diabetes (ICMR-INDIAB) study was observed to be 11.4% [3]. The scenario in the tribal population of India is more or less similar as the diabetes prevalence in tribal areas was observed to be from 0.7-10.1% [4] which is an alarming figure, but still, a systematic tribe-wise prevalence data is meager. Also, land alienation, lack of health management infrastructure, low connectivity, and technological challenges add up to their condition. While various technologies are challenging to implement due to electricity, network...
Show MoreDear Editor,
The recent paper “Profiles of health literacy and digital health literacy in clusters of hospitalised patients: a single-centre, cross-sectional study” generates insights into the health literacy characteristics of patients. We commend the authors for their efforts to enhance health equity by examining the types of patients who may require additional health literacy support when hospitalised. The authors’ comprehensive analysis of both health literacy and digital health literacy offers a strong foundation for future research, particularly in enhancing health equity by identifying vulnerable populations in hospital settings. This rapid response aims to emphasise two key areas of the analysis where further elaboration could enhance the study's quality and insights: the potential influence of the study's context on the findings and the practical implications of the generated clusters.
Health literacy refers to an individual’s ability to maintain health through knowledge, self-management, and collaboration with health professionals [1]. The paper defines health and digital health literacy as involving “access, understanding, appraisal, and use” of health information. The measurement tools reflect this broad perspective. Data was collected from a single clinical setting, and while the authors note limited generalisability, more discussion on the influence of contextual factors would have been helpful. The field would benefit from further c...
Show MorePages