Medical informatics and the Internet in medicine最新文献

Recent use of the Internet as a source of health information has raised concerns about consumers' ability to tell 'good' information from 'bad' information. Although consumers report that they use source credibility to judge information quality, several observational studies suggest that consumers make little use of source credibility. This study examines consumer evaluations of web pages attributed to a credible source as compared to generic web pages on measures of message quality. In spring 2005, a community-wide convenience survey was distributed in a regional hub city in Ohio, USA. 519 participants were randomly assigned one of six messages discussing lung cancer prevention: three messages each attributed to a highly credible national organization and three identical messages each attributed to a generic web page. Independent sample t-tests were conducted to compare each attributed message to its counterpart attributed to a generic web page on measures of trustworthiness, truthfulness, readability, and completeness. The results demonstrated that differences in attribution to a source did not have a significant effect on consumers' evaluations of the quality of the information.Conclusions. The authors offer suggestions for national organizations to promote credibility to consumers as a heuristic for choosing better online health information through the use of media co-channels to emphasize credibility.

The objectives were to assess the quality of websites in Spanish public hospitals by means of a validated system, also including measures of readability and accessibility. A scale was designed and validated to assess the quality (citizen-orientated) of the websites of hospitals. The quality of the of public hospital websites was evaluated by means of the results of the above evaluation scale, analysis of the readability of their contents, and the results of the accessibility test. The validated scale contains 73 elements or attributes. Analysis of the concordance of website evaluations shows average assessment values of between 0.80 and 0.81, which confirms a high degree of agreement among jurors. Twenty per cent of the attributes do not appear on any websites, and 14% are present on all of them. The average mark of the hospitals is 43%. The marks given for readability of tests show that it is satisfactory for 64% hospitals. None of the websites visited fulfilled the requirements necessary to be considered as accessible. The quality of the websites analysed by means of this scale varies from 23% to 62%. Differences in the size or location of the hospitals do not explain this high level of variability. The results suggest that the readability of websites should be improved and that such sites should be accessible to people with disabilities.

OpenSDE is an application that supports clinicians with structured recording of narrative patient data to enable use of data in both clinical practice and research. OpenSDE is based on a rationale and requirements for structured data entry. In this study, we analyse the impact of the rationale and the requirements on data representation using OpenSDE. Three paediatricians transcribed 20 paper patient records using OpenSDE. The transcribed records were compared; the findings that were the same in content but differed in representation (e.g. recorded as free text instead of in a structured manner) were categorized in one of three categories of difference in representation. The transcribed records contained 1764 findings in total. The medical content of 302 of these findings was represented differently by at least one clinician and was thus included in this study. In OpenSDE, clinicians are free to determine the degree of detail at which patient data are described. This flexibility accounts for 87% of the differences in data representation. Thirteen per cent of the differences are due to clinicians interpreting and translating phrases from the source text and transcribing these to (different) concepts in OpenSDE. The differences in data representation largely result from initial design decisions for OpenSDE.

Today, radio-frequency ablation has been shown to be a safe and effective method to treat paroxysmal tachycardia with Wolff-Parkinson-White syndrome. The many criteria reported for localizing the sites of accessory pathways from a 12-lead electrocardiogram have not proven adequate to differentiate the correct sites of accessory pathways for all situations. This study trained an artificial neural network to differentiate the varied features needed to localize 10 sites of accessory pathways. One hundred fifty patients underwent successful catheter ablation, with manifest single and antegradely conducting accessory pathways. Using the two electrocardiogram features of polarity of delta wave and R wave's share of QRS complex, an artificial neural network learned the characteristics of electrocardiogram waves for each site of the 10 accessory pathways through 90 learning cases, and an applicable network model was developed for testing. In 58 of 60 test cases (96.7%), sites of accessory pathways were localized correctly by the network. Based on the method employed in the present study, it thus becomes possible to predict the sites of accessory pathways with Wolff-Parkinson-White syndrome in more detail by using an artificial neural network with a 12-lead electrocardiogram. In the future, when this method is incorporated into a conventional automatic electrocardiogram system which could analyze delta waves and ORS complex, it will become useful to automatically diagnose the locations of the accessory pathways with Wolff-Parkinson-White syndrome in clinical practice.

Statistics provides essential tool in Bioinformatics to interpret the results of a database search or for the management of enormous amounts of information provided from genomics, proteomics and metabolomics. The goal of this project was the development of a software tool that would be as simple as possible to demonstrate the use of the Bioinformatics statistics. Computer Simulation Methods (CSMs) developed using Microsoft Excel were chosen for their broad range of applications, immediate and easy formula calculation, immediate testing and easy graphics representation, and of general use and acceptance by the scientific community. The result of these endeavours is a set of utilities which can be accessed from the following URL: http://gmein.uib.es/bioinformatica/statistics. When tested on students with previous coursework with traditional statistical teaching methods, the general opinion/overall consensus was that Web-based instruction had numerous advantages, but traditional methods with manual calculations were also needed for their theory and practice. Once having mastered the basic statistical formulas, Excel spreadsheets and graphics were shown to be very useful for trying many parameters in a rapid fashion without having to perform tedious calculations. CSMs will be of great importance for the formation of the students and professionals in the field of bioinformatics, and for upcoming applications of self-learning and continuous formation.

Vast amounts of consumer-based health care information are widely available on the World Wide Web. However, for some this material is inaccessible due to reliance on specialized computer equipment or software known as assistive technology. These tools, designed for people with sensory, physical, or learning disabilities, act as a median to interpret Web pages in accessible ways. Unfortunately, many websites, including those with health-related content are not designed to accommodate this equipment. No research has yet been published examining the extent of this problem in Canadian consumer-oriented health care sites. The purpose of this study was to investigate the percentage of accessible consumer-based health care websites of Canadian origin. A listing of such sites was randomly sampled for study inclusion. Each was assessed for accessibility based on the World Wide Web Consortium (W3C) Web Accessibility Initiative (WAI) Web Content Accessibility Guidelines (WCAG) 1.0 using the validation software Bobby. The results indicated that only about 40% of pages investigated were free of errors in accordance with WCAG 1.0 Priority 1 level. Websites should be constructed in compliance with these standards to better accommodate those using assistive devices.

The impact of information and communication technology (ICT) is indirect and depends on redesign of practices and structures also outside health care. Improvements will only be realized if all parties involved can coordinate their efforts to take advantage of new technology. A 'package' of changed work practices and structures extending across organizational boundaries needs to be designed and implemented. This is very different from the common conception of introducing new ICT tools. Calls for 'evaluation of benefits' before new ICT systems are introduced need to recognize this complexity. This article investigates how analysis and economic evaluations can be used to improve decision-making when new applications are proposed. This is done by drawing parallels with experiences from other industries. We conclude that the entire 'change package' should be analysed for its consequences on the well-being of care recipients, and the requirements it presents for capital investments and changed labour inputs, in particular changed competence needs. Some concepts and structures are suggested for such evaluations.

A project was developed for the creation of an Internet-based network aimed at improved management of home care activities in brain-injured children. At the patient's side, a home care unit was provided, made of a portable medical device, and a tablet PC. Measured clinical data were blood oxygen saturation, heart rate, breath rate and quantity of movement. Thanks to device portability, the patient was free to move while measurements were taken. At prescribed time intervals, measured data were automatically transmitted to the tablet PC via Bluetooth. From the tablet PC, data were transmitted remotely to a Service Centre (via ADSL or GPRS) and made available for consultation by health care professionals through the project Web portal. At the portal, other functionalities were also available, both for patients and families, and for professionals (such as weekly planning agenda, access to relevant information resources, communication tools). Information was delivered for the right participant through a workflow engine. A first trial involving nine patients was performed for two months. At the end, although some improvements were suggested, good acceptance was detected, and 78% of patients and families claimed to be interested in further use of the platform.

In clinical practice, the clinician is challenged with symptoms and/or signs at times apparently insoluble by diagnostic and/or therapeutic means. We propose that in these cases, we have to use an EBM approach in which evidence may be looked up in every available clinical report and bibliographic databases are used for searching that evidence. We report on a case of ulcerative skin lesions apparently insoluble by expert dermatologists following a conventional diagnostic and therapeutic process. We use this case report for illustrating a systematic approach to resolve diagnostic and therapeutic questions using a bibliographic database search (like MEDLINE and EMBASE). Both a systematic approach to bibliographic databases and a critically appraised topic on case reports (or case series) are needed to 'rehabilitate' low-level evidences (that is a case report or case series) to a higher level when we approach decision-making of uncommon clinical pictures. We demonstrate the possibility of using bibliographic databases to search and retrieve useful information for decision-making of uncommon clinical pictures. The method we have proposed can be applied in every area of the world, especially in rural areas. Finally, an Internet-shared database of uncommon clinical pictures with critically appraised topics could be useful in saving more time.

Catalogues of medical E-learning modules offer easy access to learning material that is available on the World Wide Web (WWW) free of charge. Therefore, a study was conducted on the retrieval performance of four WWW-based catalogues: CAL reviews, KELDAmed, LMU, and LRSMed. LRSMed is run by the authors. Completeness was calculated pairwise. Two reviewers checked the availability of 80 modules independently. Five criteria were chosen to calculate accuracy: gynaecology and microbiology as medical fields; case study as type of learning resource; diabetes mellitus and AIDS as free-text diagnoses. Also, two reviewers evaluated independently whether the module is really an appropriate resource for that criterion or not. The analysis is based on a consensual decision about the correct votes. From the URLs, 93% were available at the evaluation of completeness, 92% at the evaluation of accuracy. The kappa values for inter-rater reliability were 0.83 and 0.36. The best service offers 60.8% of the pooled E-learning resources. The resources retrieved by the five criteria were rated as correct in 69.3% (LRSMed), 76.6% (KELDAmed), and 82.7% (CAL reviews). The overall accuracy was 76.7%. Medical students and other potential users of E-learning modules should be aware that the completeness of WWW-based catalogues in this area is not satisfying. The retrieval accuracy is better; four of five resources offered correspond with the search criterion. Up to now, most of the services miss an application-programming interface that could be used for a meta-search to improve completeness.