Medical informatics and the Internet in medicine最新文献

The objective was to explore a relationship between the economics of religion and the attributes of online patient groups by testing the hypotheses that (1) the harsher the entry requirements to an online patient group, the more active its members are; and (2) membership homogeneity in a given group is reflected in the educational level of group members. Online groups were randomly chosen from the 'Yahoo groups' category of 'Illnesses'. The hypothesis about entry requirements was narrowed by defining those requirements as either 'Open', 'Register', or 'Closed'. The number of messages over a 4-month period in each of 162 different groups was tallied. The hypothesis about membership homogeneity was refined by counting the citations in messages and by predicting the educational level of members (as reflected in the average word length of messages) based on these citation counts. Across 162 groups, the number of messages was significantly less in Open groups than in Register groups and less in Register groups than in Closed groups. Across 14 groups, the average word length of messages in a group positively correlated with the number of citations in that group. The hypothesis is supported that increased group entry barriers correspond to increased group message activity and members tend to be similar within a group. These attributes could be used to help design effective groups.

The use of wireless networks bears great practical importance in instantaneous transmission of ECG signals during movement. In this paper, three typical wavelet-based ECG compression algorithms, Rajoub (RA), Embedded Zerotree Wavelet (EZ), and Wavelet Transform Higher-Order Statistics Coding (WH), were evaluated to find an appropriate ECG compression algorithm for scalable and reliable wireless tele-cardiology applications, particularly over a CDMA network. The short-term and long-term performance characteristics of the three algorithms were analyzed using normal, abnormal, and measurement noise-contaminated ECG signals from the MIT-BIH database. In addition to the processing delay measurement, compression efficiency and reconstruction sensitivity to error were also evaluated via simulation models including the noise-free channel model, random noise channel model, and CDMA channel model, as well as over an actual CDMA network currently operating in Korea. This study found that the EZ algorithm achieves the best compression efficiency within a low-noise environment, and that the WH algorithm is competitive for use in high-error environments with degraded short-term performance with abnormal or contaminated ECG signals.

Besides the overall budget for building the infrastructure of a healthcare-service-based virtual private network (VPN) in Taiwan, two issues were considered critical for its acceptance by the country's 17,000 plus medical institutions. One was who was to pay for the network (ADSL or modem) connection fee; the other was who was to pay for the firewall/anti-virus software. This paper addresses the second issue by proposing an efficient freeware firewall, named card-assisted firewall (CAF), for NHI VPN edge-hosts, which is also an add-on-value application of the National Healthcare IC card that every insurant and medical professional has. The innovative concept is that any NHI VPN site (edge-host) can establish diversified secure-authenticated connections with other sites only by an authentication mechanism, which requires a NHI Java card state machine and the Access Control List of the host. It is different from two-factor authentication cards in four ways: (1) a PIN code is not a must; (2) it requires authentication with the remote IC card Data Centre; (3) the NHI cards are already available, no modification is needed, and there is no further cost for the deployment of the cards; (4) although the cards are in the reader, the communication cannot start unless the cards are in the corresponding states; i.e. the states allow communication. An implementation, on a Microsoft Windows XP platform, demonstrated the system's feasibility over an emulation of the NHI VPN framework. It maintained a high line speed, the driver took up 39 KB of disk space, installation was simple, not requiring any extra hardware or software, and the average packet processing time of the CAF driver measured was 0.3084 ms. The average overhead in comparing the Access Control List predefined routing in card, in an FTP testing experiment, was 5.7 micros (receiving) and 8 micros (sending).

Computers, personal digital assistants (PDA), and the Internet are widely used as resources in medical education and clinical care. Educators who intend to incorporate these resources effectively into residency education programmes can benefit from understanding how residents currently use these tools, their skills, and their preferences. The researchers sent questionnaires to 306 US family medicine residency programmes for all of their residents to complete. Respondents were 1177 residents from 125 (41%) programmes. Access to a computer was reported by 95% of respondents. Of these, 97% of desktop and 89% of laptop computers could access the Internet. Residents accessed various educational and clinical resources. Half felt they had 'intermediate' skills at Web searches, 23% had 'some skills,' and 27% were 'quite skilled.' Those under 30 years of age reported higher skill levels. Those who experienced a Web-based curriculum in medical school reported higher search skills and greater success in finding clinical information. Respondents preferred to use technology to supplement the didactic sessions offered in resident teaching conferences. Favourable conditions exist in family medicine residency programmes to implement a blend of traditional and technology-based learning experiences. These conditions include residents' experience, skills, and preferences.

This work presents a new dictionary-based approach to biomedical cross-language information retrieval (CLIR) that addresses many of the general and domain-specific challenges in current CLIR research. Our method is based on a multilingual lexicon that was generated partly manually and partly automatically, and currently covers six European languages. It contains morphologically meaningful word fragments, termed subwords. Using subwords instead of entire words significantly reduces the number of lexical entries necessary to sufficiently cover a specific language and domain. Mediation between queries and documents is based on these subwords as well as on lists of word-n-grams that are generated from large monolingual corpora and constitute possible translation units. The translations are then sent to a standard Internet search engine. This process makes our approach an effective tool for searching the biomedical content of the World Wide Web in different languages. We evaluate this approach using the OHSUMED corpus, a large medical document collection, within a cross-language retrieval setting.

The use of the Internet is growing rapidly. Up to 70% of American Internet surfers use the Web for some kind of medical purpose. Only a few studies characterized the consulting population and their inquiries. The objective of this study was to define the content of queries and the characteristics of the consulting population in an open access 'Ask the family physician' non-commercial open forum. Data had been collected from the family medicine forum in www.doctors.co.il. This site has 10 - 15 new queries daily, and a physician reply is given on most occasions within 24 h. We analysed demographic characteristics and the content of the queries. In addition, we sent detailed questionnaires to 200 randomly selected consulters. We analysed 1,002 consecutive queries. The average age of the consulters was 31.8 years, 63.4% women. Women applied more often for someone else, compared to men (13.7 versus 8%p = 0.01). 82.2% applied to the forum for a first opinion on the subject matter. The most frequent subjects were: infectious diseases (7.3%), deciphering blood chemical analysis results (3.2%), vitamin B(12) (3.2%), deciphering blood count analysis results (2.9%), Epstein - Barr virus and Cytomegalovirus (2.8%), and hypertension (2.4%). Only 10% (20/200) replied to our e-mail questionnaire. We described the characteristics of inquiries to a Web-based question answering service. Its consumers are mainly younger females who consult the virtual physician prior to consulting their own family physician. They mainly seek medical knowledge especially in interpreting laboratory tests and information about various medical conditions.

The aim of this study is to develop a web-based HIV testing belief Inventory (wHITBI) and to examine the reliability and validity of the scores of the instrument. Steps for developing the item pool are described. Students from one major university in the south-eastern US were recruited. The sample (n = 440) was randomly split into equivalent halves for an exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The EFA showed that the wHITBI items were loaded in a way consistent with the four theoretical constructs: perceived benefits, concerns of HIV risk, perceived stigma, and availability/accessibility. CFA using LISREL 8.7 confirmed the structure of the inventory indicated by good model-fit indices (chi(2)/d.f. = 1.79; root mean square error of approximation = .06; non-normed fit index = .89; comparative fit index = .90; incremental fit index = .91; root mean square = .07), with all factors loaded significantly (p < .001). The composite reliability ranged from .67 to .76. The results also showed that these scales can distinguish well among HIV-tested and never-tested students. The validated wHITBI has implications on future applications for the development and evaluation of HIV prevention and education programs delivered via the Internet.

The medical trauma record, produced in the Accident & Emergency Departments (AEDs) receives much attention from both health-care professionals and parties interested in quality of care. While it is an important data source for health-care professionals in their everyday work, and for quality assessment by third parties, the (paper) medical record is usually negatively evaluated because of incompleteness. In this article, we show that completeness is relative to the purpose for which the record is used. We distinguish two contexts in which the trauma record is used: the primary-care process at the AED, and assessment and monitoring of trauma care. Incompleteness of the medical record is valued differently in these contexts. Especially with regard to the information demands of quality assessment, and more specifically the national trauma registry, the work processes in the AED have not evolved sufficiently as yet. Information technology has great power to improve completeness and to facilitate quality assessment, but it cannot solve the problem of incompleteness in itself. One solution we propose is to restructure the recording process by introducing a clerk. This clerk could also be a nurse or physician who is temporarily released from direct patient care.

Non-adherence to physician recommendations is common and is thought to lead to poor clinical outcomes. However, no techniques exist for a large-scale assessment of this phenomenon. We evaluated a computational approach that quantifies patient non-adherence from an analysis of the text of physician notes. Index of non-adherence (INA) was computed based on the number of non-adherence word tags detected in physician notes. INA was evaluated by comparing the results to a manual patient record review at the individual sentence and patient level. The relationship between INA and frequency of Emergency Department visits was determined. The positive predictive value of identification of individual non-adherence word tags was 93.3%. The Pearson correlation coefficient between the INA and the number of documented instances of non-adherence identified by manual review was 0.62. The frequency of ED visits was more than twice as high for patients with INA in the highest quartile (least adherent) than for patients with INA in the lowest (most adherent) quartile (p < 0.0001). We have described the design and evaluation of a novel approach that allows quantification of patient non-adherence with physician recommendations through an analysis of physician notes. This approach has been validated at several levels and demonstrated to correlate with clinical outcomes.

New findings are continuously identified thanks to novel diagnostic procedures, among others in medical imaging. It would be useful to retrieve these new findings from literature. The aim of this work is to investigate if using verbs in MEDLINE queries can improve the retrieval of findings. Verbs used in the field of findings were selected: 'to show' (an examination shows a finding) and 'to confirm' (a finding confirms a diagnosis). For each of these verbs, semantically close verbs were researched on the WordNet website. Then, the extent to which adding these verbs to a query about various radiological pathologies can improve findings retrieval in Medline citations was studied. This method has been tested on two sets of MEDLINE citations regarding the diagnostic imaging of musculo-skeletal disorders. Using appropriate verbs in Medline queries enhances the precision from 53% to 61% and from 53% to 74%, respectively, in our first and second test set. A recall of 74% and 83% was reached in our two experiments. Using relevant verbs can be a rather simple way to improve the retrieval of findings related to diseases and diagnostic procedures from Medline citations.