Medical informatics and the Internet in medicine最新文献

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.