A biopsychosocial understanding of lower back pain: Content analysis of online information.

OBJECTIVES: (1) To develop a checklist to assess the representation of biopsychosocial lower back pain (LBP) online information; (2) to analyse publicly accessed online LBP information from a Google search for the degree that psychosocial contributors are described alongside the traditional biomedical approach to explaining LBP; (3) whether websites use information on pain biology to educate on LBP; (4) any inaccurate or false information regarding the mechanisms of LBP and; (5) the amount of websites certified by established benchmarks for quality health information. MATERIALS AND METHODS: An online search was conducted using the Google search engines of six major English-speaking countries. Website content was analysed using three checklists developed for the purpose of this study - Biopsychosocial information categorisation checklist and scoring criteria; pain biology information checklist; and the inaccurate information checklist. Website quality was identified by the presence of an Health on the Net certification (HONcode). RESULTS: Of the fifteen websites analysed, the content of 26.7% of websites was classified as 'biomedical', 60% 'limited psychosocial' and 13.3% 'reasonable psychosocial'; 20% included information on pain biology; 46.7% inaccurately implied pain to be equal to tissue damage and 46.7% implied pathways specific to pain transmission; 40% were HONcode certified. CONCLUSION: Online LBP information retrieved through a Google search has limited to no integration of psychosocial or pain biology information. The focus on tissue pathology is further supported by the inaccurate descriptions of pain as equal to tissue damage and as an input to the central nervous system (CNS). Online LBP information needs to be guided by criteria more sensitive to the psychosocial contributors to pain. SIGNIFICANCE: The online LBP information retrieved from a Google search needs to be guided by information more sensitive to the psychosocial contributors to pain and disability. This study also highlights the presence of inaccurate information that implied pain as a measure of tissue damage or as an input to the nervous system.

Improving the quality of communicable disease control: the example of meningococcal disease.

Improving the quality of health services is central to current attempts to reform the National Health Service. The main approaches to quality improvement in communicable disease control to date have been the development of practice guidelines and audit projects. Descriptions of the impact of quality initiatives in public health generally and communicable disease in particular have been limited, objective measures of quality are rare and few reports outline improvements that have been achieved in practice. We describe a project to develop a set of quality indicators for meningococcal disease control. A set of candidate indicators was developed and screened using standard approaches based on local consensus. We outline how they could be further tested and used to promote quality improvement.

Providing feedback to students on clinical skills by using the Objective Structured Clinical Examination.

Student opinions of some methods of how and when to provide feedback on clinical skills in the Objective Structured Clinical Examination (OSCE) were gathered. Feedback with their marked checklists plus a model videorecording was preferred to either on its own. Feedback was preferred during the examination rather than after it. No undue stress appeared to be associated with receiving feedback during the examination. Valuable extra instruction to students can be provided with minimal staff input.