Medical informatics and the Internet in medicine最新文献

Advances in wireless technology give pace to the rapid development of mobile applications. The coming mobile revolution will bring dramatic and fundamental changes to our daily life. It will influence the way we live, the way we do things, and the way we take care of our health. For the healthcare industry, mobile applications provide a new frontier in offering better care and services to patients, and a more flexible and mobile way of communicating with suppliers and patients. Mobile applications will provide important real time data for patients, physicians, insurers, and suppliers. In addition, it will revolutionalize the way information is managed in the healthcare industry and redefine the doctor - patient communication. This paper discusses different aspects of mobile healthcare. Specifically, it presents mobile applications in healthcare, and discusses possible challenges facing the development of mobile applications. Obstacles in developing mobile healthcare applications include mobile device limitations, wireless networking problems, infrastructure constraints, security concerns, and user distrust. Research issues in resolving or alleviating these problems are also discussed in the paper.

Visible Human Dataset (VHD) is a remarkable piece of raw digital anatomical knowledge still to be fully exploited. Colours of VHD anatomic images are the natural targets of different algorithmic approaches devoted to understanding the content of the complex digital medical images, but they have never been analysed exhaustively. A full colorimetric characterization of all 9000 VHD colour images may help to take advantage of implicit available information in raw data. This study describes a novel colorimetric characterization and a Visual Knowledge Discovery tool, using methods from database field, data visualization, and image analysis. The applied heterogeneous methods allowed us to develop a histogram meta database and make it available remotely. It consists of a histogram-based colorimetric characterization of the all VHD 24-bit colour images. A user-friendly, interactive, and intuitive 3D framework providing 3D services was built and made freely available. It allows real-time analysis of colour component characteristics of a user-defined set of VHD images providing 3D interactive navigation of the histogram meta database. New knowledge can be discovered using our tool and the histogram meta database provided. This work allowed us to propose novel methods for colour image characterization and obtained results using developed service on VHD colour images let us to partially understand the not fully satisfactorily results achieved so far analysing these images.

We describe here a six-year-long project during which groups of radiologists belonging to various hospitals in Extremadura (one of Spain's regions) shared their clinical experience over the Internet in a process of continuing medical education. We designed a set of tools based on the most familiar Internet protocols (the WWW and e-mail) that make computer-mediated communication very straightforward. Periodically, each group put forward a clinical case of interest, presenting it on a Web page. The other participating groups discussed the case (in real or deferred time), describing the radiological findings, proposing a differential diagnosis, and making suggestions concerning the case. The clinical case was subsequently resolved by the proposing group on the basis of definitive diagnostic tests, and posted for public access on the Internet as a teaching file to form part of a cases-of-interest archive. As of present, more than 65 cases have been presented and discussed, and 55 posted as teaching files. At about halfway through the project, the participants were asked to respond to a questionnaire. In their responses, they indicated a high degree of acceptance of the system, finding no special difficulties in the use of the tools. They also reported having incorporated some of the procedures (consultation of clinical cases on Internet, access to information specifically targeted at radiologists, consulting specialist literature, etc.) into their work habits.

Bio-ontology is a formal representation of biological concepts that is used in the interchange of communication between computers and humans alike. They can then be used in the formulation and retrieval of knowledge. In developing a knowledge-based system for Parkinson's Disease, a procedure of knowledge map was used to capture and harness the intellectual resources of an organization, and new paradigms for knowledge mapping were also formulated. Knowledge bases for symptoms and drugs, physiotherapy, speech and language therapy, and dieting that affect patient care were developed. Finally, the knowledge bases were merged to form a single central repository of knowledge base.

Primary objective: Confidence levels, clinical significance curves and risk - benefit contours have recently been developed with the aim of improving the interpretation of clinical studies. It has been suggested that their use may complement traditional methods of result reporting (i.e. p values and 95% confidence intervals), and subsequently improve medical decision-making. These new methods have been used to report study results; however, widespread use may be hampered by the lack of available computer software. Our objective was to design user-friendly software to enable researchers to use these statistical methods.

Research design: A spreadsheet was designed to calculate these statistics for the assessment of two arm medical studies. The spreadsheet was tested using a wide range of input data and operating systems. User-friendliness was tested by researchers who had no background in statistics.

Main outcomes and results: The confidence calculator was successfully designed, and found to be user-friendly. The spreadsheet is MS Excel-based to allow wide usage. The spreadsheet is freely available from the author and from the web site http://www.primercollaboration.com/Tools/tools.html.

Conclusions: We have successfully designed a spreadsheet that is simple to use and freely accessible for researchers. This is the first such software that calculates confidence levels, clinical significance curves, and risk - benefit contours.

Primary objective: to assess the readability level of Web-based information on leading incident cancers.

Research design: websites on breast, prostate, and colorectal cancers were selected for analysis by comparing the first 100 hits across 10 popular search engines. A total of 100 websites on breast (n=33), prostate (n=34), and colorectal (n=33) cancers were included in the final analysis.

Methods: readability was assessed using SMOG, Flesch-Kincaid (F - K), and Flesch Reading Ease (FRE) measures. SMOG was hand-calculated on 10 - 30 lines of continuous text. Identical text was entered into Microsoft Word 2002 where F - K and FRE scores were determined automatically by the word processor.

Results: the mean readability score of the cancer websites was Grade 12.9 using SMOG and Grade 10.7 according to F - K. The mean FRE score was 45.3, a score considered 'difficult'. Colorectal cancer websites were most difficult to read compared to breast and prostate cancer websites. All measures indicated that prostate cancer websites were written at the lowest readability. Significantly higher reading levels were required for concluding paragraphs of Web articles compared to introduction paragraphs.

Conclusions: findings suggest the need for readable cancer information on the Web. Health promoters, health informaticians, medical journalists, and web page editors must collaborate to ensure the use of plain language to match the literacy skills of consumers.

Background: Expanding Internet-based interventions for substance use will have little benefit if heavy substance users are unlikely to have Internet access. This paper explored whether access to the Internet was a potential barrier to the provision of services for smokers, drinkers and illicit drug users.

Methods: As part of a general population telephone survey of adults in Ontario, Canada, respondents were asked about their use of different drugs and also about their use of the Internet.

Results: Pack-a-day smokers were less likely (48%) to have home Internet access than non-smokers (69%), and current drinkers (73%) were more likely to have home access than abstainers (50%). These relationships remained true even after controlling for demographic characteristics. Internet access was less clearly associated with cannabis or cocaine use.

Conclusions: Even though there is variation in access among smokers, drinkers and illicit drug users, the World Wide Web remains an excellent opportunity to potentially provide services for substance abusers who might never access treatment in person because, in absolute terms, the majority of substance abusers do use the Internet.

UniNet is an Internet-based thematic network for a virtual community of users (VCU). It supports one multidisciplinary community of doctoral students, who receive most of the courses on the network. The evident advantages of distance learning by Internet, in terms of costs, comfort, etc., require a previous evaluation of the system, focusing on the learning outcomes of the student. The aim was to evaluate the real learning of the students of doctorate courses, by comparing the effectiveness of distance learning in UniNet with traditional classroom-based teaching. Five doctorate courses were taught simultaneously to two independent groups of students in two ways: one, through the UniNet Network, and the other in a traditional classroom. The academic knowledge of students was evaluated at the beginning and end of each course. The difference in score was considered as a knowledge increase. The comparison was made using Student's t-test for independent groups. There were no significant statistical differences in the outcomes of the two groups of students. This suggests that both teaching systems were equivalent in increasing the knowledge of the students. Both educational methods, the traditional system and the online system in a thematic network, are effective and similar for increasing knowledge.

Computer simulation of clinical encounters is increasingly used in clinical settings to train patient work-up. The aim of this prospective, controlled study was to compare the characteristics of data collection and diagnostic exploration of physicians working up cases with a standardized patient and in a computerized simulation. Six clinicians of different clinical experience in internal medicine worked up three cases with a standardized patient and through a computer simulation allowing free inquiry. After each encounter, we asked the subjects to justify the information collected and to comment on their working diagnoses. The characteristics of data collected and working diagnoses generated were assessed and compared, according to the simulation method used. In the computer simulation, physicians limited their data collection and focused earlier and more specifically on information and working diagnoses with high levels of relevance. They reached a similar diagnostic accuracy and made decisions of a similar relevance. Computer simulation with a free-inquiry approach reproduces the data collection and the diagnostic exploration observed in a standardized-patient simulation and promotes an early collection of relevant data. Its contribution to extend the competence of learners in clinical settings should be further evaluated.

A software framework for the development of Web-based medical education is proposed. The objective is to optimize the development process by introducing Learning Objects (LO) and Learning Object Classes (LO Classes) so that the content preparation can be separated from the educational issues, ergonomic design, and technical realization. Based on the concept of case-based, problem-oriented education, different learning scenarios were analysed and then modelled as different LOs. These LOs can be further abstracted in several reusable LO Classes that represent certain patterns of content structure, pedagogical concept, and user interface. With the help of LO input templates, the educational material can be prepared by the authors in the authoring process easily and appropriately. An LO content management system was developed to store and maintain different LOs and to generate the Web-presentation of LOs adaptively and dynamically in the tutoring process. This software framework has been applied to the exemplary development of an interactive course in orthopaedics. The LOs and LO Classes also help to maintain consistency of the course representation to users. As a result, more efficiency in the development phase and good usability and quality of the end products can be achieved.