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ICT-based health information services for elderly people: past experiences, current trends, and future strategies. 基于信息通信技术的老年人健康信息服务:过去的经验、当前的趋势和未来的战略。
Pub Date : 2007-12-01 DOI: 10.1080/14639230701692736
Michael Marschollek, Stefan Mix, Klaus-H Wolf, Beate Effertz, Reinhold Haux, Elisabeth Steinhagen-Thiessen

Although health information is readily available on the Internet and has changed the way people deal with their health in many ways, the retrieval of relevant information remains problematic, especially for elderly people. With a focus on elderly people, this paper summarizes current trends in consumer health informatics, discusses past and present initiatives providing health-information services, and proposes a future strategy for the design of sustainable services. A systematic literature review and a review of past German and EU projects concerned with health information services for elderly people are given. Many publications focus on health information services for specific diseases and on their quality and semantic accessibility, yet few deal with presenting and customizing health information for elderly and disabled people. Past experiences from Germany suggest that very often the specific needs of this target group are not met, and therefore accessibility remains largely hypothetical. We propose a strategy with five key points for the design of sustainable health-information services for elderly people. More research is needed to customize web-based health information services to the needs of the user group that needs them most urgently - elderly and disabled people.

尽管健康信息可以在因特网上随时获得,并在许多方面改变了人们处理健康问题的方式,但相关信息的检索仍然存在问题,特别是对老年人而言。本文以老年人为重点,总结了消费者健康信息学的当前趋势,讨论了过去和现在提供健康信息服务的举措,并提出了可持续服务设计的未来策略。系统的文献审查和审查过去的德国和欧盟项目有关老年人的健康信息服务。许多出版物侧重于特定疾病的卫生信息服务及其质量和语义可及性,但很少涉及为老年人和残疾人提供和定制卫生信息。德国过去的经验表明,这一目标群体的具体需要往往得不到满足,因此可及性在很大程度上仍然是一种假设。我们提出了一个可持续的老年人健康信息服务设计策略,包括五个要点。需要更多的研究来定制基于网络的卫生信息服务,以满足最迫切需要这些服务的用户群体——老年人和残疾人的需求。
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引用次数: 68
Readability and cultural sensitivity of web-based patient decision aids for cancer screening and treatment: a systematic review. 可读性和文化敏感性的基于网络的患者决策辅助癌症筛查和治疗:一个系统的回顾。
Pub Date : 2007-12-01 DOI: 10.1080/14639230701780408
M D Thomson, L Hoffman-Goetz

Decision aids (DA) can inform cancer screening. We conducted a systematic review of web-based, cancer DA to evaluate their appropriateness for use with low literacy and diverse culture groups. Eighty-one Internet DA were found searching five databases (Pubmed-Medline; Web of Science/SSCI; Cancerlit; CINAHL; and Google) and the Cochrane decision aid inventory. Twenty-three met key inclusion criteria of (1) informing cancer screening or treatment decisions, (2) being patient or consumer oriented, and (3) conforming to the Cochrane definition of DA. DA were evaluated using the International Patient Decision Aid Standards checklist, the Cultural Sensitivity Assessment Tool (CSAT), the Cultural Sensitivity Assessment Checklist (CSAC), and the SMOG readability formula. DA had a high readability with 74% (n = 17) written at the grade 10 - 13, 22% (n = 5) at the grade 9, and 4% (n = 1) at the grade 8 level. Visual aids were used in 35% (n = 8) to present probability information. Written information was complemented with video or audio components in 35% (n = 8). Most (91%, n = 21) were developed for generic audiences, while 9% (n = 2) specified a cultural group. Although DA enabled a step-by-step movement through the website, none allowed key word searches and only 65% permitted document printing. Most DA included difficult texts and were not focused for specific cultural groups.

决策辅助(DA)可以为癌症筛查提供信息。我们对基于网络的癌症DA进行了系统回顾,以评估其在低文化和不同文化群体中使用的适宜性。在5个数据库(Pubmed-Medline;科学网/SSCI;Cancerlit;CINAHL;和谷歌)以及Cochrane决策辅助量表。23篇符合以下关键入选标准:(1)为癌症筛查或治疗决策提供信息,(2)以患者或消费者为导向,(3)符合Cochrane对DA的定义。使用国际患者决策辅助标准检查表、文化敏感性评估工具(CSAT)、文化敏感性评估检查表(CSAC)和烟雾可读性公式对DA进行评估。数据具有较高的可读性,74% (n = 17)在10 - 13年级,22% (n = 5)在9年级,4% (n = 1)在8年级。35% (n = 8)的患者使用视觉辅助工具来呈现概率信息。35% (n = 8)的书面信息辅以视频或音频成分。大多数(91%,n = 21)是为普通受众开发的,而9% (n = 2)是为特定的文化群体开发的。虽然DA可以在网站上一步一步地移动,但没有一个允许关键字搜索,只有65%的人允许文档打印。大多数DA包括困难的文本,而不是针对特定的文化群体。
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引用次数: 60
Patients' perceptions of Internet usage and their opportunity to obtain health information. 患者对互联网使用的看法及其获取健康信息的机会。
Pub Date : 2007-12-01 DOI: 10.1080/14639230701819792
Maritta Välimäki, Heljä Nenonen, Marita Koivunen, Riitta Suhonen

The World Wide Web is increasingly an essential resource to obtain information for health promotion. Coherent information is still missing as to whether patients' opportunities to use the Internet and to access health information have changed at the same time. This study examines and compares, between two different time periods, patients' perceptions of Internet use, to obtain health information and associated factors. A two-stage survey design with a non-equivalent group was used. The data were collected with questionnaires from hospital patients during their discharge process and analysed using descriptive statistics. The vast majority of the patients had Internet access either at home or work. The proportion of Internet usage increased during the study period. Patients agree on the importance of using technology for health-information delivery, but they still prefer to receive information from health-care staff by face-to-face contacts. Well-educated and young respondents reported more frequent access to the Internet.

万维网日益成为获取促进健康信息的重要资源。关于患者使用互联网和获取健康信息的机会是否同时发生了变化,仍然缺乏连贯的信息。本研究考察并比较两个不同时期患者对互联网使用的看法,以获得健康信息和相关因素。采用非等效组的两阶段调查设计。通过对住院患者出院过程的问卷调查收集数据,并采用描述性统计方法进行分析。绝大多数患者在家中或工作场所都可以上网。在研究期间,互联网的使用比例有所增加。患者同意使用技术提供卫生信息的重要性,但他们仍然倾向于通过面对面接触从卫生保健工作人员那里获得信息。受过良好教育的年轻人更频繁地访问互联网。
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引用次数: 42
Assisting the transition from hospital to home for children with major congenital heart disease by telemedicine: a feasibility study and initial results. 通过远程医疗协助患有严重先天性心脏病的儿童从医院转到家庭:可行性研究和初步结果。
Pub Date : 2007-12-01 DOI: 10.1080/14639230701791611
B McCrossan, G Morgan, B Grant, A Sands, B Craig, F Casey

Parents of children hospitalized with major congenital heart disease often state that the weeks following discharge from hospital are particularly difficult. There is a sudden change from 24-h medical supervision and care to outpatient reviews. Videoconferencing not only gives the family an opportunity to have visual and audio contact with staff but also allows clinicians to visually assess the patient. We have investigated the feasibility of using videoconferencing to provide support for families at home. We also report the early results of a randomized control trial comparing videoconference support with regular telephone support and the current clinic review follow-up.

患有严重先天性心脏病的儿童的父母经常说,出院后的几周特别困难。从24小时医疗监督和护理突然转变为门诊复查。视频会议不仅使家属有机会与工作人员进行视频和音频接触,而且使临床医生能够从视觉上评估患者。我们已经研究了利用视频会议为家庭提供支持的可行性。我们还报告了一项随机对照试验的早期结果,该试验比较了视频会议支持与常规电话支持以及当前的临床回顾随访。
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引用次数: 25
Digital pens and pain diaries in palliative home health care: professional caregivers' experiences. 姑息性家庭保健中的数字笔和疼痛日记:专业护理人员的经验。
Pub Date : 2007-12-01 DOI: 10.1080/14639230701785381
Leili Lind, Daniel Karlsson, Bengt Fridlund

Frequent pain assessment by the use of pain diaries for the follow-up of pain treatment can facilitate the caregivers' work with pain control in home health care. The aim was to explore and describe professional caregivers' experiences of palliative home health-care patients' use of pain diaries and digital pen technology for frequent pain assessment. A system for the follow-up of pain treatment was implemented in routine care and evaluated by means of a qualitative content analysis. Three nurses, two physicians and one secretary were interviewed. Additional analysis data were collected from patients' medical records, and the system log. The caregivers showed a shifting outlook towards the pain-assessment method, an initial cautious outlook due to low expectations of the patients' abilities to use the pain assessment method. Despite this, the caregivers experienced positive outcomes in terms of an increased awareness of pain, and positive patient influences including increased participation in their care, increased security, and improved changes in pain treatment as a response to reported pain assessments. Pain assessment by the use of pain diaries and digital pen technology has positive influences on palliative home-care patients and supports the caregivers' focus on the pain.

通过使用疼痛日记对疼痛治疗进行频繁的疼痛评估,可以促进护理人员在家庭保健中控制疼痛的工作。目的是探索和描述专业护理人员对姑息性家庭保健患者使用疼痛日记和数字笔技术进行频繁疼痛评估的经验。在常规护理中实施疼痛治疗随访系统,并通过定性内容分析进行评价。采访了三名护士、两名医生和一名秘书。从患者的医疗记录和系统日志中收集了其他分析数据。护理人员对疼痛评估方法的态度发生了转变,最初的态度是谨慎的,因为对患者使用疼痛评估方法的能力期望不高。尽管如此,护理人员在提高疼痛意识方面取得了积极的成果,并对患者产生了积极的影响,包括增加了对护理的参与,增加了安全性,并根据报告的疼痛评估改善了疼痛治疗的变化。使用疼痛日记和数字笔技术进行疼痛评估对姑息家庭护理患者有积极影响,并支持照顾者对疼痛的关注。
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引用次数: 24
Knowledge-based generation of diagnostic hypotheses and therapy recommendations for toxoplasma infections in pregnancy. 基于知识的妊娠期弓形虫感染诊断假设和治疗建议的生成。
Pub Date : 2007-09-01 DOI: 10.1080/14639230701446570
Dieter Kopecky, Klaus-Peter Adlassnig, Andrea-Romana Prusa, Michael Hayde, Yoichi Hayashi, Birgit Panzenböck, Andrea Rappelsberger, Arnold Pollak

Primary infection of pregnant women with the parasite Toxoplasma gondii results in infections of the unborn by transplacental transmission in about 50% of the cases. The degree of possible damage depends on the duration of parasitical impact on fetal tissues. The web-based software system ToxoNet processes the results of serological antibody tests performed during pregnancy by means of a knowledge base containing medical knowledge on the interpretation of toxoplasmosis serology findings. For this purpose, it matches the results of all serological investigations of maternal blood with the content of the knowledge base and generates interpretive reports consisting of a diagnostic hypothesis, recommendations for therapy, and proposals for further investigations. Fuzzy sets are used to formalize certain intervals between subsequent investigations to take the varying immune responses of individual patients into account. In a retrospective study, ToxoNet classified 100% of the trivial serological cases and about 87.8% of the more complex cases correctly. ToxoNet comprises a knowledge base, a system for interpretation, and a knowledge acquisition and modification program. It is available on the WWW by accessing a medical knowledge-base server via standard browsers.

孕妇初次感染弓形虫后,约50%的病例通过经胎盘传播导致胎儿感染。可能的损害程度取决于寄生对胎儿组织影响的持续时间。基于网络的软件系统ToxoNet通过包含有关解释弓形虫病血清学结果的医学知识的知识库处理妊娠期间进行的血清学抗体检测结果。为此,它将母体血液的所有血清学调查结果与知识库的内容相匹配,并生成解释性报告,包括诊断假设、治疗建议和进一步调查建议。模糊集用于形式化后续调查之间的特定间隔,以考虑个体患者的不同免疫反应。在一项回顾性研究中,弓形虫对简单血清学病例的正确率为100%,对更复杂的病例的正确率约为87.8%。弓形虫包括一个知识库、一个解释系统以及一个知识获取和修改程序。通过标准浏览器访问医学知识库服务器,就可以在WWW上获得它。
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引用次数: 4
Are we measuring the right end-points? Variables that affect the impact of computerised decision support on patient outcomes: a systematic review. 我们测量的终点是否正确?影响计算机化决策支持对患者结果影响的变量:一项系统综述。
Pub Date : 2007-09-01 DOI: 10.1080/14639230701447701
Vitali Sintchenko, Farah Magrabi, Steven Tipper

Previous reviews of electronic decision-support systems (EDSS) have often treated them as a single category, and factors that may modify their effectiveness of EDSS have not been examined. The objective was to summarise the evidence associating the use of computerised decision support and improved patient outcomes. PubMed/Medline and the Database of Abstracts were searched for randomised controlled trials (RCT) of EDSS from 1 January 1994 to 31 January 2006. Twenty-four RCT studies from 97 reviewed were selected, eight of them examined systems supporting decisions for patients who presented with an acute illness, and 16 studies enrolled patients with chronic conditions. Overall, 13 (54%) of the studies showed a positive result, and 11 (46%) were with no impact. Critiquing and consultative systems showed the impact in 71% and 47% of studies, respectively. All systems targeting decisions related to acute disease improved patient outcomes compared with 38% of systems focused on the management of chronic conditions (P = 0.005). Provision of EDSS improves prescribing practices and treatment outcomes of patients with acute illnesses; however, EDSS were less effective in primary care. Complex interventions as clinical EDSS may require new metrics of assessment to describe the impact on patient outcomes.

以往对电子决策支持系统(EDSS)的审查往往将其视为单一类别,并且没有审查可能改变其EDSS有效性的因素。目的是总结使用计算机化决策支持与改善患者预后相关的证据。检索PubMed/Medline和摘要数据库,检索1994年1月1日至2006年1月31日EDSS的随机对照试验(RCT)。从97项综述中选择了24项RCT研究,其中8项研究检查了支持急性疾病患者决策的系统,16项研究纳入了慢性疾病患者。总体而言,13项(54%)研究显示出积极的结果,11项(46%)研究没有影响。批评和咨询系统分别在71%和47%的研究中显示了影响。所有针对急性疾病决策的系统都改善了患者的预后,而专注于慢性疾病管理的系统只有38% (P = 0.005)。EDSS的提供改善了急性病患者的处方做法和治疗结果;然而,EDSS在初级保健中效果较差。像临床EDSS这样的复杂干预可能需要新的评估指标来描述对患者预后的影响。
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引用次数: 54
Obtrusiveness of information-based assistive technologies as perceived by older adults in residential care facilities: a secondary analysis. 住宿护理机构中老年人所感知的信息辅助技术的突兀性:一项二次分析。
Pub Date : 2007-09-01 DOI: 10.1080/14639230701447735
Karen L Courtney, George Demiris, Brian K Hensel

With the anticipated growth in the older adult population in the next few years, information designers are examining new ways for assistive technologies to support independent living and quality of life for adults as they age. Central to the role of assistive technology to support and enhance quality of life is the development of non-obtrusive technologies. Despite the importance of non-obtrusiveness to the design of assistive technologies, there remains no standard definition of obtrusiveness or measurement instrument. A conceptual framework for obtrusiveness in home telehealth technologies has recently been proposed but has not yet been tested empirically. This project performed a secondary analysis of focus group and interview data to explore the presence of the dimensions of the obtrusiveness framework in older adults' responses to information-based assistive technologies in residential care facilities. We found the existing data contained examples of each dimension (physical, usability, privacy, function, human interaction, self-concept, routine, and sustainability) and 16 of the 22 subcategories proposed by the obtrusiveness framework. These results provide general support for the framework, although further prospective validation research is needed. Potential enhancements to the framework are proposed.

随着未来几年老年人口的预期增长,信息设计师正在研究辅助技术的新方法,以支持成年人随着年龄的增长而独立生活和提高生活质量。辅助技术在支持和提高生活质量方面的核心作用是开发非突发性技术。尽管非突兀性对辅助技术的设计很重要,但对于突兀性或测量仪器仍然没有标准的定义。最近提出了家庭远程医疗技术中突兀性的概念框架,但尚未经过经验检验。本研究透过焦点小组与访谈资料,探讨突兀性框架的各维度是否存在于安老院舍长者对资讯辅助技术的回应中。我们发现现有的数据包含了每个维度(物理、可用性、隐私、功能、人际互动、自我概念、常规和可持续性)的例子,以及突兀性框架提出的22个子类别中的16个。这些结果为该框架提供了总体支持,尽管还需要进一步的前瞻性验证研究。提出了对该框架的潜在增强。
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引用次数: 61
WAERS: an application for Web-assisted estimation of relative survival. WAERS:一个网络辅助估计相对生存的应用程序。
Pub Date : 2007-09-01 DOI: 10.1080/14639230601185575
Ramon Clèries, Joan Valls, Laura Esteban, Jordi Gálvez, Laura Pareja, Xavier Sanz, Luisa Alliste, José Miguel Martínez, Víctor Moreno, Xavier Bosch, Josep Maria Borràs, Josepa Maria Ribes

Net cancer survival estimation is usually performed by computing relative survival (RS), which is defined as the ratio between observed and expected survival rates. The mortality of a reference population is required in order to compute the expected survival rate, which can be performed using a variety of statistical packages. A new Web interface to compute RS, called WAERS, has been developed by the Catalan Institute of Oncology. The reference population is first selected, and then the RS of a cohort is computed. A remote server is used for this purpose. A mock example serves to illustrate the use of the tool with a hypothetical cohort, for which RS is estimated based on three different reference populations (a province of Spain, an autonomous community (Region), and the entire Spanish population). At present, only mortality tables for different areas of Spain are available. Future improvements of this application will include mortality tables of Latin American and European Union countries, and stratified (control variable) analysis. This application can be also useful for cohort mortality studies and for registries of several diseases.

净癌症生存估计通常通过计算相对生存(RS)来进行,RS定义为观察到的生存率与预期生存率之间的比率。为了计算预期存活率,需要参考种群的死亡率,这可以使用各种统计软件包来执行。加泰罗尼亚肿瘤研究所开发了一种新的计算RS的网络界面,叫做WAERS。首先选择参考人群,然后计算队列的RS。远程服务器用于此目的。一个模拟示例用于说明该工具与假设队列的使用,其中RS是根据三个不同的参考人群(西班牙的一个省、一个自治区(地区)和整个西班牙人口)估计的。目前,只有西班牙不同地区的死亡率表。该应用程序的未来改进将包括拉丁美洲和欧盟国家的死亡率表,以及分层(控制变量)分析。该应用程序也可用于队列死亡率研究和几种疾病的登记。
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引用次数: 9
Virtual palpation of skeletal landmarks with multimodal display interfaces. 具有多模态显示界面的骨骼地标的虚拟触诊。
Pub Date : 2007-09-01 DOI: 10.1080/14639230701231493
Fulvia Taddei, Mauro Ansaloni, Debora Testi, Marco Viceconti

The 3D location of skeletal landmarks on CT datasets is an important procedure, used in many research and clinical contexts. The standard procedure involves the segmentation of the CT images, the creation of a 3D surface bone model, and the location of the landmarks on this surface. However, the segmentation is time-consuming and requires skilled operators and sophisticated software. The aim of the present study is to evaluate the efficacy of a multimodal display interface to direct volumetric interactive visualization in performing a virtual palpation task. An expert operator used the CT dataset of a patient's thigh region to locate 14 femoral skeletal landmarks. This operation was repeatedly performed using different CT data representation; the accuracy and repeatability were compared to those achievable with the conventional procedure based on the segmented 3D surface. When a multimodal display interface (formed by an orthogonal slice, RXCT and interactive isosurface views) was used to perform the virtual palpation directly on the CT data, the average coordinates of the landmarks did not differ significantly from those located on the 3D surface, and the measurement repeatability was actually better with the multimodal display of the volumetric data than with the 3D surface. Thus, we can conclude that skeletal virtual palpation can be performed directly on the CT dataset, as far as the virtual palpation is performed with a multimodal display interface.

CT数据集上骨骼地标的三维定位是一个重要的程序,用于许多研究和临床环境。标准程序包括对CT图像进行分割,创建3D表面骨骼模型,并在该表面上定位地标。然而,分割是耗时的,需要熟练的操作员和复杂的软件。本研究的目的是评估多模态显示界面在执行虚拟触诊任务时直接体积交互式可视化的功效。专家操作员使用患者大腿区域的CT数据集来定位14个股骨骨骼地标。使用不同的CT数据表示重复进行该操作;将该方法的精度和重复性与基于三维曲面分割的传统方法进行了比较。当使用多模态显示界面(由正交切片、RXCT和交互式等值面视图组成)直接对CT数据进行虚拟触诊时,地标的平均坐标与位于三维表面上的地标的平均坐标没有显著差异,并且体积数据的多模态显示的测量重复性优于三维表面。因此,我们可以得出结论,只要使用多模态显示界面进行虚拟触诊,骨骼虚拟触诊可以直接在CT数据集上进行。
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引用次数: 24
期刊
Medical informatics and the Internet in medicine
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