Medical informatics and the Internet in medicine最新文献

Introduction: Internet use by the public to obtain medical information and services continues to grow. In 1999, we found cost of general physician visits was 15% higher, and cost of medications was 10% greater via the Internet than from community providers. The goal of this study was to re-examine changes in product availability and costs to consumers four years later.

Design: We searched multiple websites 1 June 2003 - 31 August 2004, offering physician consultations and prescription medications. We compared mean cost of Internet physician visits and price per pill to costs of community-based general physicians and pharmacies in the Philadelphia region.

Results: We found 144 sites worldwide providing physician services and prescription medications. Mean charge for an Internet physician consultation was 55 dollars, 8.3% lower than for a comparable visit to a community practitioner. Mean cost per pill across 204 available medications was 36.7% higher at Internet sites than at local pharmacies. Shipping and handling (S&H) added a mean of 15.40 dollars. Total cost to Internet consumers was similar whether or not Internet sites charged for a physician consultation and/or S&H. Obtaining physician visits and medications over the Internet was about 40% more costly than in the local community.

Conclusion: The Internet continues to hold great promise for provision of health and medical care services by expanding access. However, increased access to physician care and medications entails higher cost, and quality of physician services and pharmaceuticals provided remain controversial.

The aim of this study is to investigate the characteristics of the Internet users in Croatia related to seeking health information, which information they seek, the reasons, and the outcomes of that information on them. We surveyed the users of the Internet health portal 'Cybermed', in spring 2003 and autumn 2004. Responses were collected from a pop-up questionnaire, which appeared at every website visit. There were 369 respondents in 2003 and 580 respondents in 2004. Most respondents were women (82% in 2003 and 80% in 2004). While more than half of the respondents (55%) in 2003 had a college or university degree, this changed in 2004, when only 40% of respondents had a college or university degree (P < 0.001). Also, we recorded a significant age-related change, suggesting that the average age of the respondents increased in 2004 (P < 0.001). The leading motivation for seeking medical information was 'unanswered questions after visiting a physician'. Most respondents (90% in 2003, 87% in 2004) went online to seek information on a specific illness or condition. Women sought information for friends and colleagues more often than men (42% vs. 28%, P = 0.031) in 2003, while these differences were diluted in 2004. Approximately half of all respondents discussed the information they found online with their physicians. Patients who feel they were given insufficient information, or simply seek more information than the physician provided, turn to using online health information, which no longer seems to be reserved to those with the highest education degrees. Health-care providers should consider creating health-related Internet portals, supplementing the information they provide.

Background: Single-channel video is an established method for assessing clinical consultation in training general practitioners; however, it is hard to infer the body language of the doctor or how information in the consultation is being integrated into the medical record. A three-channel video was developed combining the conventional view with a camera looking at the doctor's facial expression and copying the video output from the monitor. However, the choice of three channels and camera angles selected has not been critically appraised.

Objective: To develop criteria for comparing single and multi-channel approaches to video recording of the consultation.

Methods: Single channel and three-channel recordings of simulated consultations were shown to a panel of 12 health professionals and interviews were conducted to gather their opinions on the level of information presented, quality and assessment. The transcripts were analysed thematically.

Results: It was found that in providing visual information the three-channel video was superior to the single channel video. The major elements needed for comparison of the two techniques would be the ability of the video to pick up quantifiable non-verbal communication of the doctor and the patient, and the ability to qualitatively and quantitatively reflect the use and impact of the computer on the consultation. The information provided by the three-channel video could be further classified to essential, desirable and redundant to guide the future development of the multi-channel video.

Conclusions: Multi-channel methods should be able to capture the following information: body language and facial expression of doctor and patient; and how the doctor's knowledge and information collected in the consultation are synthesized into the medical record.

The aim of this study was to assess the accuracy of a six-degrees-of-freedom application for pre-operative planning of total hip replacement in a virtual reality (VR) environment. A test was performed estimating the system inherent accuracy. The users can move objects in the VR environment with an intrinsic accuracy almost four orders of magnitude greater than the object dimension. A second unambiguous and relevant task was defined to assess the accuracy achievable with the interface in a specific planning task. The results were compared with those obtained with 2D interfaces for both the stem and the cup component. The RMSE was assumed as an indicator of the achievable accuracy. The accuracy of the immersive interface was comparable with that achievable with a standard mouse - monitor interface. The users were consistent using the VR interface, confirming the high usability of the new interface and the steep learning curve of users unfamiliar with the new environment. This study has demonstrated that the application of VR environment for pre-operative planning of total hip replacement may help to shorten the duration of the positioning and to yield consistent results even with first-time users.

To determine whether definable subtypes exist within a cohort of Hong Kong nurses as related to the clinical management system use in their clinical practices based on their knowledge, attitudes, skills, and background factors. Data were collected using a structured questionnaire. The sample of 242 registered nurses was recruited from three hospitals in Hong Kong. The study employs personal and demographic variables, knowledge, attitudes, and skills scale. A cluster analysis yielded two clusters. Each cluster represents a different profile of Hong Kong nurses on the clinical management system use in their clinical practices. The first group (Cluster 1) was labeled 'lower attitudes, less skilful and average knowledge' group, and represented 55.4% of the total respondents. The second group (Cluster 2) was labeled as 'positive attitudes, good knowledge but less skilful'. They comprised almost 44.6% of this nursing sample. Cluster 2 had more older nurses, the majority were educated to the baccalaureate or above level, with more than 10 years working experience, and they held a more senior ranking then Cluster 1. A clear profile of Hong Kong nurses may benefit healthcare professionals in making appropriate education or assistance to prompt the use of the clinical management system by nurses an officially recognized profession. The findings were useful in determining nurse-users' specific needs and their preferences for modification of the clinical management system. Such findings should be used to formulate strategies to encourage nurses to resolve actual problems following computer training and to increase the depth and breadth of nurses' knowledge, attitudes, and skills toward such system.

The use of new information technologies could facilitate enormously work to process and spread knowledge from medical data and, in particular, epidemiological data from cancer registries. Cancer registries are official institutions that collect information on the occurrence and outcome of cancer in defined population groups (city, region, or country). The aim of the present project was to design and develop a graphical web system to offer clear information about medical information, in this case cancer incidence, using Internet technology. A protocol and a system to process, manipulate, and represent medical data, epidemiological cancer data, from the Epidemiology Unit and Cancer Registry of the Balearic Islands, has been developed. All the steps to change the data format to obtain a medical data graphical representation database have been described. The result of the project is an application built in graphical web format that can be accessed at the following URL: http://gmein.uib.es/registro/resultados/resultados2.htm

Privacy has been and continues to be one of the key challenges of an age devoted to the accumulation, processing, and mining of electronic information. In particular, privacy of healthcare-related information is seen as a key issue as health organizations move towards the electronic provision of services. The aim of the research detailed in this paper has been to analyse privacy policies on popular UK healthcare-related websites to determine the extent to which consumer privacy is protected. The author has combined approaches (such as approaches focused on usability, policy content, and policy quality) used in studies by other researchers on e-commerce and US healthcare websites to provide a comprehensive analysis of UK healthcare privacy policies. The author identifies a wide range of issues related to the protection of consumer privacy through his research analysis using quantitative results. The main outcomes from the author's research are that only 61% of healthcare-related websites in their sample group posted privacy policies. In addition, most of the posted privacy policies had poor readability standards and included a variety of privacy vulnerability statements. Overall, the author's findings represent significant current issues in relation to healthcare information protection on the Internet. The hope is that raising awareness of these results will drive forward changes in the industry, similar to those experienced with information quality.

Psychological trauma is a major public-health problem, and trauma victims frequently turn to the Internet for medical information related to trauma. The Internet has many advantages for trauma victims, including low cost, privacy, use of access, and reduced direct social interactions. However, there are no regulations on what is posted on the Internet, or by whom, and little is known about the quality of information currently available related to the topic of psychological trauma. The purpose of this study was to evaluate the quality of Internet sites related to the topic of psychological trauma. The top 20 hits for searches on Google, AllTheWeb, and Yahoo were tabulated, using search words of 'psychological trauma', 'stress', 'PTSD', and 'trauma'. From these searches, a list of 94 unique unsponsored hits that represented accessible websites was generated. Fourteen sites were unrelated or only peripherally related, and eight were related but were not comprehensively evaluated because they represented brochures, online book sales, etc. Seventy-two websites underwent evaluation of the content, design, disclosure, ease of use, and other factors based on published guidelines for medical information sites. Forty-two per cent of sites had inaccurate information, 82% did not provide a source of their information, and 41% did not use a mental-health professional in the development of the content. Ratings of content (e.g. accuracy, reliability, etc.) were 4 (2 SD) on a scale of 1 - 10, with 10 being the best. There were similar ratings for the other variables assessed. These findings suggest that although abundant, websites providing information about psychological trauma are often not useful, and can sometimes provide inaccurate and potentially harmful information to consumers of medical information.

Orthotopic liver transplant (OLTx) has evolved to a successful surgical management for end-stage liver diseases. Awareness and information about OLTx is an important tool in assisting OLTx recipients and people supporting them, including non-transplant clinicians. The study aimed to investigate the nature and quality of liver transplant-related patient information on the World Wide Web. Four common search engines were used to explore the Internet by using the key words 'Liver transplant'. The URL (unique resource locator) of the top 50 returns was chosen as it was judged unlikely that the average user would search beyond the first 50 sites returned by a given search. Each Web site was assessed on the following categories: origin, language, accessibility and extent of the information. A weighted Information Score (IS) was created to assess the quality of clinical and educational value of each Web site and was scored independently by three transplant clinicians. The Internet search performed with the aid of the four search engines yielded a total of 2,255,244 Web sites. Of the 200 possible sites, only 58 Web sites were assessed because of repetition of the same Web sites and non-accessible links. The overall median weighted IS was 22 (IQR 1 - 42). Of the 58 Web sites analysed, 45 (77%) belonged to USA, six (10%) were European, and seven (12%) were from the rest of the world. The median weighted IS of publications originating from Europe and USA was 40 (IQR = 22 - 60) and 23 (IQR = 6 - 38), respectively. Although European Web sites produced a higher weighted IS [40 (IQR = 22 - 60)] as compared with the USA publications [23 (IQR = 6 - 38)], this was not statistically significant (p = 0.07). Web sites belonging to the academic institutions and the professional organizations scored significantly higher with a median weighted IS of 28 (IQR = 16 - 44) and 24(12 - 35), respectively, as compared with the commercial Web sites (median = 6 with IQR of 0 - 14, p = .001). There was an Intraclass Correlation Coefficient (ICC) of 0.89 and an associated 95% CI (0.83, 0.93) for the three observers on the 58 Web sites. The study highlights the need for a significant improvement in the information available on the World Wide Web about OLTx. It concludes that the educational material currently available on the World Wide Web about liver transplant is of poor quality and requires rigorous input from health care professionals. The authors suggest that clinicians should pay more attention to take the necessary steps to improve the standard of information available on their relevant Web sites and must take an active role in helping their patients find Web sites that provide the best and accurate information specifically applicable to the loco-regional circumstances.

The aim of our study was to evaluate the use of the medical Internet by midwifery students with analysis of influencing factors and students' preferences. A prospective cross-sectional questionnaire study was carried out with 180 midwifery students. The response rate was 83.8%, 82% use the Internet, and 79.3% use the medical resources in their education. The mean accession to the Web is 5.3 +/- 8.4 times per month. The mean evaluation of information resources for books, journals, conferences and university courses was 6.6 +/- 3.2, 4.8 +/- 3.1, 2.7 +/- 3.0, and 6.8 +/- 3.8, respectively, as measured with the Visual Analogue Scale (p < 0.001). Age did not correlate with Internet use and its evaluation but correlated with a self-evaluation of Internet skills as a user (Rs = -0.20, p = 0.016). The evaluation of the Internet as a source of medical knowledge correlated with self-evaluation of medical search skills (Rs = 0.66, p < 0.001) and user skills (Rs = 0.61, p < 0.001). The medical Internet is used by the majority of midwifery students, but it is still a secondary source of information, after university training and medical books. The higher evaluation of Internet correlated with general computer skills and medical search skills, which suggests the need for education on Internet use by students.