Health On The Net Research Articles

Health information quality on the internet for bladder cancer and urinary diversion: a multi-lingual analysis.

Bladder cancer patients undergoing radical cystectomy and urinary diversion are faced with difficult decisions regarding mode of urinary diversion. Although these patients may use the Internet as a guide to diagnosis and treatment options, online resources remain largely unregulated leading to a great variation in quality of medical information. Further variation in quality is seen between languages. Fortunately, tools such as an automated toolbar developed by the World Health Organization Health on the Net (HON) Foundation exist to assist physicians in recommending quality online health information to patients. We set out to compare and assess the quality of bladder cancer, ileal conduit and orthotopic neobladder web sites in 2016 on the basis of the HON principles for English language. The Google search engine imbedded with the HON toolbar was used to assess 1350 Web sites using the keywords "bladder cancer", "ileal conduit" and "orthotopic neobladder" in English, Italian and Spanish. The first 150 results of each search were identified and screened. A further analysis was completed comparing results between 2009 and 2016. Less than 20% of English, Italian and Spanish "bladder cancer" and urinary diversion ("ileal conduit" and "orthotopic neobladder") web sites are HON-accredited. HON-accredited web sites featured preferentially in the first 50 search results for bladder cancer (P=0.0001) and ileal conduit (P=0.03) web sites. Comparing 2016 results to 2009, percentage of HON-accreditation has not shown statistically significant change (-13%, P=0.23), while overall number of search results has increased (+44%). A lack of validation of bladder cancer sites is present, which is consistent across modes of urinary diversion (orthotopic neobladder and ileal conduit) and languages. It is important that physicians involved in the care of bladder cancer patients undergoing radical cystectomy and urinary diversion participate in the development of informative, ethical, and reliable health Web sites and direct patients to them.

Health on the Net: Do Website Searches Return Reliable Health Information on Hemorrhoids and Their Treatment?

Objective: To analyze the quality of health information on the Internet on hemorrhoids across 5 Western languages and perform a comparative analysis of website sponsors. Summary of background data: Hemorrhoids are a common condition affecting the hemorrhoid cushions of the anal canal. Many treatment options are available. Information on the Internet on hemorrhoids is considered variable, but there is little data analysis to support this. The World Health Organization's Health On the Net (HON) accredits medical and health websites based on a code of conduct and publishes a toolbar that aids identification of such accredited websites. Methods: Using the Google search engine (http://www.google.com, Google, Mountain View, California), searches were performed using 11 keywords related to hemorrhoids in English, French, German, Italian, and Spanish. Health On the Net accreditation was determined to assess quality website information. The first 150 websites in each language had their adherence to the HON principles analyzed, and English websites were analyzed to determine sponsorship source. Results: Of the 8250 websites analysed, 586 (7.1%) were found to HON-accredited. The rate of HON accreditation ranged from 2.0% (piles) to 10.0% (hemorrhoids), with higher-ranking results having higher rates of HON accreditation (P < 0.001). Conclusion: There is a paucity of high-quality information on the Internet; however, the Google search algorithm prioritizes high-quality information in its web search results.

Online Information on the Treatment of Burning Mouth Syndrome: Quality and Readability

To evaluate the quality and readability of online information about the treatment of burning mouth syndrome (BMS). An internet search using the phrase "burning mouth syndrome treatment" was carried out on the Google search engine (www.google.co.uk) on 8 June 2015, and the first 100 websites listed were examined. Data collection included DISCERN score, the Journal of the American Medical Association (JAMA) benchmarks for website analysis score, the presence of the Health on the Net (HON) Foundation seal, and the Flesch Reading Ease Score (FRES). Descriptive statistics were performed using Microsoft Office Excel. The search strategy initially yielded 635,000 links; following the application of the exclusion criteria, 53 sites remained for analysis. The overall DISCERN score varied between websites, with half of all websites achieving an overall score of 2 and none of these websites achieving the maximum score of 5. The mean score ± standard deviation (SD) was 2.4 ± 0.7. Only 10 (18.9%) of the websites achieved the four JAMA benchmarks while 3 (5.7%) of the websites did not achieve any of them. Only 9 (17%) displayed the HON seal. The FRES of the websites ranged from 32.4 to 82.2; the mean ± SD rating was 55.4 ± 10.7, which is considered to reflect fairly difficult reading. The information available online about BMS is of questionable quality and content. Perhaps engaging patients in determining what type and format of information they desire when searching online for health information could guide clinicians and researchers alike in providing reliable and readable information sources.

Breast reconstruction post mastectomy- Let's Google it. Accessibility, readability and quality of online information

IntroductionThis study evaluated the readability, accessibility and quality of information pertaining to breast reconstruction post mastectomy on the Internet in the English language. MethodsUsing the Google© search engine the keywords “Breast reconstruction post mastectomy” were searched for. We analyzed the top 75 sites. The Flesch Reading Ease Score and Gunning Fog Index were calculated to assess readability. Web site quality was assessed objectively using the University of Michigan Consumer Health Web site Evaluation Checklist. Accessibility was determined using an automated accessibility tool. In addition, the country of origin, type of organisation producing the site and presence of Health on the Net (HoN) Certification status was recorded. ResultsThe Web sites were difficult to read and comprehend. The mean Flesch Reading Ease scores were 55.5. The mean Gunning Fog Index scores was 8.6. The mean Michigan score was 34.8 indicating weak quality of websites. Websites with HoN certification ranked higher in the search results (p = 0.007). Website quality was influenced by organisation type (p < 0.0001) with academic/healthcare, not for profit and government sites having higher Michigan scores. 20% of sites met the minimum accessibility criteria. ConclusionsInternet information on breast reconstruction post mastectomy and procedures is poorly written and we suggest that Webpages providing information must be made more readable and accessible. We suggest that health professionals should recommend Web sites that are easy to read and contain high-quality surgical information. Medical information on the Internet should be readable, accessible, reliable and of a consistent quality.

‘Can you recommend any good STI apps?’ A review of content, accuracy and comprehensiveness of current mobile medical applications for STIs and related genital infections

ObjectiveSeeking sexual health information online is common, and provision of mobile medical applications (apps) for STIs is increasing. Young people, inherently at higher risk of STIs, are avid users of...

Surfing Behind a Boat: Quality and Reliability of Online Resources on Scaphoid Fractures.

Patients seeking information and advice on treatment of scaphoid fractures unknowingly confront longstanding medical controversies surrounding the management of this condition. However, there are no studies specifically looking into the quality and reliability of online information on scaphoid fractures. We identified 44 unique websites for evaluation using the term "scaphoid fractures". The websites were categorized by type and assessed using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria and the Health on the net (HON) code. The majority of websites were commercial (n = 13) followed by academic (n = 12). Only seven of the websites were HON certified. The mean DISCERN score was 43.8. Only 4 websites scored 63 or above representing excellent quality with minimal shortcomings but 13 websites scored 38 or below representing poor or very poor quality. The mean JAMA benchmark criteria score was 2.2. The Governmental and Non-Profit Organizations category websites had the highest mean JAMA benchmark score. The websites that displayed the HON-code seal had higher mean DISCERN scores and higher mean JAMA benchmark scores compared to websites that did not display the seal. Good quality health information is certainly available on the Internet. However, it is not possible to predict with certainty which sites are of higher quality. We suggest clinicians should have a responsibility to educate their patients regarding the unregulated nature of medical information on the internet and proactively provide patients with educational resources and thus help them make smart and informed decisions.

Quality of Information Available Via the Internet for Patients With Otological Conditions.

Evaluate the type, content, and quality of information available via the Internet for patients with common otological conditions. The Google search engine was used to generate responses for the following search terms: glue ear, otitis media, otosclerosis, Ménière's disease, cholesteatoma, and ear perforation. The first 10 websites for each search term were selected for analysis. Websites were evaluated with the validated DISCERN instrument (Institute of Health Sciences, University of Oxford, UK), the LIDA tool (Minervation Ltd, Oxford, UK), the Flesch Readability Formula, the Simple Measure Of Gobbledygook (SMOG) readability score, and against the Journal of the American Medical Association (JAMA) criteria. Comparisons were made with a similar study assessing quality of information in nonotological conditions. Mean SMOG score was 12.19 years of education (range, 6.2-22.8). The health on the net (HON) symbol appeared on 15 of 49 websites (30.61%). Pearson's r was used to identify interactions between variables and demonstrated a significant correlation between LIDA score and Google ranking (R = -0.1195, p = 0.002); between university/hospital affiliation and JAMA score (R = -1.7889, p = 0.0182) and commercial affiliation and JAMA score (R = 1.0561; p = 0.01). Multivariate linear regression analysis showed LIDA to be the strongest predictor of Google ranking (Page rank decreasing by 0.10572 per LIDA score; p = 0.01). As websites with better Google ranking were only weakly associated with higher quality rankings patients would benefit from being directed to reliable websites by clinicians. There is currently a gap in the available resources for a high quality repository of otological information aimed at patients.

Popular apps on the medical category targeting patients and the general public in the United Kingdom: Do they conform to the Health On the Net Foundation principles?

Smartphones with their rising popularity and versatile software 'apps' have great potential for revolutionising healthcare services. However, this was soon overshadowed by concerns highlighted by many studies over quality. These were subject and/or discipline specific and mostly evaluated compliance with a limited number of information portrayal standards originally devised for health websites. Hence, this study aimed to take a broader approach by evaluating the most popular apps categorised as medical in the United Kingdom for compliance with all of those standards systematically using the Health On the Net (HON) Foundation principles. The study evaluated top 50 free and paid apps of the 'medical' category on both iTunes and Google stores for evidence of compliance with an app-adapted version of the HON Foundation code of conduct. The sample included 64 apps, 34/64 (53%) were on Google Play and 36/64 (56%) were free. None of the apps managed to comply with the entire eight principles. Compliance with seven principles was achieved by only one app (1.6%), and the rest were compliant with three, two, and one (14.7%, 27%, and 38%, respectively). In conclusion, this study demonstrated that most popular apps on the medical category that are available in the United Kingdom do not meet the standards for presenting health information to the public, and this is consistent with earlier studies. Improving the situation would require raising the public awareness, providing tools that would assist in quality evaluation, encouraging developers to use robust development process, and facilitating collaboration and engagement among the stakeholders.

Health information quality on the internet in gynecological oncology: a multilingual evaluation.

Oncological internet information quality is considered variable, but no comprehensive analysis of gynecological malig- nancies exists. The present authors' objectives were to compare the quality of common malignancy websites and to assess for language or disease differences; and secondly, to perform a quality comparison between medical and layperson terminology. World Health Organization (WHO) Health on the Net (HON) principles may be applied to websites using an automated toolbar function. Using a search engine (www.Google.com) 8,400 websites were assessed using keywords 'endometrial, 'uterine', 'cervical', 'ovarian', 'vaginal', 'vulvar', plus 'cancer', in English, French, German, and Spanish; repeated for alternate terms e.g. 'cervix', 'womb'. Searches for "vaginal' 'uterine', 'cervical', and 'endometrial' each returned millions of websites. The total percentage of all assessed HON-accredited sites was notably low across all search terms (median 15%; range 3-19%). Significant differences by malignancy type (p < 0.0001), language (p < 0.0001), and tertiles (thirds) of the first 150 websites returned (p < 0.0001). French language had most accredited websites. Using alternate terms demonstrated significant differences (p < 0.001) in accredited websites for most gynecological cancers. Internet data on gynecological malignancies is overwhelming. Further, a lack of validation of the majority of gynecological oncologic sites should be appreciated with discrepancies in quality and number of websites across diseases, languages, and also between medical and layperson terms. Physicians should encourage and more importantly their professional bodies should participate in the development of informative, ethical, and reliable health websites on the internet and direct patients to them.

Raising concern about the information provided on medical travel agency websites: A place for policy

Patients are increasingly choosing to travel abroad for essential but non-urgent medical treatments, such as hip and heart valve replacements. Websites are frequently the first contact point with potential international service providers, such as medical travel agencies (MTAs). Yet only a few studies have previously assessed the standard of information provided on the websites of MTAs. This study examined the information provided by European MTA websites using a modified version of the Health on the Net (HON) code. A content analysis of the information collected assessed how the MTA websites promoted their services and communicated the risks, benefits and other issues related to medical travel. Twenty-seven websites based in thirteen different European countries were identified and coded using a modified version of the HON tool. Considerable inconsistencies across websites were noted on all domains assessed and no single item of the tool was addressed by all websites. The most frequently included item on websites was a contact form (74%), but no website provided information on risk rates, or used scientific references to support their claims. The promotion of benefits of medical travel coupled with the absence of risk communication was concerning. It is evident that there is a need for a policy which considers the regulation of MTAs and the information and services that they provide.

Discectomy-Related Information on the Internet: Does the Quality Follow the Surge?

Introduction Over 2.5 billion users search the internet world wide. 70%- 80% look at health related information, yet no standards exist regarding the publication of medical literature on the internet. The quality of health information is of much concern and an emphasis on appraisal of internet Web sites is needed. We aim to look at the quality of health information on the internet relating to discectomy using various standardised tools and scoring systems. Material and Methods The three most commonly used search engines were identified and a search for “Discectomy” was performed on each. Two reviewers categorized the most popular Web sites according to their types and the quality of each was assessed using recognized scoring systems including the Journal of the American Medical Association (JAMA) benchmark, DISCERN and a novel Discectomy-specific content score. The quality of the information was also assessed according to the presence or absence of the Health on the Net (HON) code, a reported quality-assurance marker. Results Results confirmed that 53 websites were identified, and analyzed. Commercial Web sites were predominant at 24, 7 were governmental, 6 were produced by physicians, none were produced by allied health professionals, 3 were academic, 4 were public health information Web sites, 4 were attached to social media and discussion groups, 3 were media related, and 2 were unspecified. Using the 3 scoring systems mentioned above as a quality marker, internet sites with a 'Health on the Net’ (HON) code demonstrated significantly higher quality than those without the code ( p &lt; 0.0001). Public health information Web sites attained the highest overall DISCERN and Discectomy-specific scores followed by the Governmental &amp; Non-Profit Organizations Web sites. Conclusion The overall quality of information regarding discectomy remains poor and variable despite an exponential increase in the number of users and Websites, with a slight trend toward improvement. Only 20% to 30% are of good quality, compared with that 10 years ago (&lt;10%). Presence of Health on the Net code is a very reliable marker for health information quality.

Evaluation of Patient-Oriented, Internet-Based Information on Gender-Affirming Hormone Treatments.

Transgender people have difficulty accessing gender-affirming hormone therapy (HT), a medically necessary treatment, in part due to a lack of provider knowledge. Patients often seek information on gender-affirming medical care using the Internet. Patients who are better informed about their own care may receive better care. This study evaluated the quantity and quality of online information about HT using several existing and novel measures. Structured Google searches were conducted. Sites were evaluated using previously described Journal of the American Medical Association (JAMA), DISCERN, and Health On the Net (HON) criteria, for citation of the Endocrine Society Guidelines and the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC), and other topic-specific measures. Forty sites were evaluated. The median JAMA score was 3.5/7, and the median DISCERN score was 51/80. No sites held HON certification. Citation of the Endocrine Society Guidelines and the WPATH SOC was inconsistent. Institutional sites had higher DISCERN scores compared with other sites. The presence of a bibliography was most associated with measures of quality. The quality of online information about HT is inconsistent and limited in quantity. Development of reliable online resources on HT for transgender patients is essential. Broadening awareness of key guidelines from the Endocrine Society and WPATH is essential.

Quality of Health Information on the Internet for Urolithiasis on the Google Search Engine

Purpose. To compare the quality of health information on the Internet for keywords related to urolithiasis, to assess for difference in information quality across four main Western languages, and to compare the source of sponsorship in these websites. Methods. Health On the Net (HON) Foundation principles were utilised to determine quality information. Fifteen keywords related to urolithiasis were searched on the Google search engine. The first 150 websites were assessed against the HON principles and the source of sponsorship determined. Results. A total of 8986 websites were analysed. A proportion of HON-accredited websites for individual search terms range between 2.5% and 12.0%. The first 50 websites were more likely to be HON-positive compared to websites 51–100 and 101–150. French websites searched were more likely to be HON-positive whereas German websites were less likely to be HON-positive than English websites. There was no statistically significant difference between the rate of HON-positive English and Spanish websites. The three main website sponsors were from government/educational sources (40.2%), followed by commercial (29.9%) and physician/surgeon sources (18.6%). Conclusions. Health information on most urolithiasis websites was not validated. Nearly one-third of websites in this study have commercial sponsorship. Doctors should recognise the need for more reliable health websites for their patients.

An automated HONcode detection system informs internet users of HONcode compliance

The HONcode provided by Health On the Net (HON) foundation is the most successful third party certification initiative. In nearly 20 years, it has acquired a database of over 8000 trustworthy health websites, has been translated into over 30 languages and become not only a well-respected name amongst health information providers but also an increasingly well-recognised brand amongst health information end-users. The HONcode, having begun in the mid-1990s has managed to stay current and relevant two decades on, because of its ability to change and remain relevant to the present times. The past few years have been no different, and HON has been heavily involved in bringing out certain updates to further its mission of unrestricted trustworthy health information online. In this paper we present the HONcode certification process and the main changes taking place in the certification process to enable its continued success and sustainability.

P12.03 How accurate and comprehensive are currently available mobile medical applications (apps) for sexually transmitted and genital infections: a comprehensive review

Introduction In the UK, 88% of young people, a group at high risk of STIs, own a smartphone. Seeking sexual health advice online is common and provision of STI apps is increasing. The UK lacks a robust framework for quality control of mobile medical apps and potential for misinformation is substantial. We undertook a comprehensive review of content and accuracy of contemporary apps for STIs (except HIV) and related genital infections aimed at members of the public. Methods Search of Googleplay and iTunes stores for free and paid apps regarding STIs and genital infections, testing, diagnosis and management, between 10/09/2014–16/09/2014. We assessed eligible apps against: 1) 19 modified Health on The Net (HON) Foundation principles; 2) comprehensiveness and accuracy of information on individual STIs/genital infections, and their diagnosis and management, compared with respective National Health Service STI information webpage content. Results 144/6642 apps met eligibility criteria (Android n = 94; iOS n = 29; both n = 24). 57 were excluded after downloading. 87 apps (52 Android, 20 iOS, 15 both) were analysed. Only 29% apps met >/= 6 HON criteria. Content was highly variable: 34/87 (39%) covered one or two infections; 16/34 (47%) were ebooks, predominately about genital herpes or candidiasis; 40/87 (46%) covered multiple STIs; 5/87 (6%), solely focused on accessing STI testing. In terms of accuracy: 13/87 (15%) were fully, 46/87 (53%) mostly and 28/87 (32%) partially accurate. 25/87 (29%) contained >/= 1 instance of potentially harmful information. Apps available on both platforms had a greater degree of accuracy than single platform apps. Only 1 app provided fully accurate and comprehensive information on chlamydia. Conclusion The marked variation in content, quality and accuracy of available smartphone apps combined with the relatively high proportion that contain harmful information, significantly risks undermining the potential health benefits of an e-health approach to sexual health promotion and information. Disclosure of interest statement Nothing to declare.

Perthes Disease: The Quality and Reliability of Information on the Internet.

Research has shown that up to 89% of parents used the Internet to seek health information regarding their child's medical condition. Much of the information on the Internet is valuable; however, the quality of health information is variable and unregulated. The aim of this study was to evaluate the quality and content of information about Perthes disease on the Internet using recognized scoring systems, identification of quality markers, and describe a novel specific score. We searched the top 3 search engines (Google, Yahoo!, and Bing) for the following keywords: "Perthes disease." Forty-five unique Web sites were identified. The Web sites were then categorized by type and assessed using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria, and a novel Perthes-specific Content score. The presence of the Health On the Net (HON) code, a reported quality assurance marker, was noted. Of the Web sites analyzed, the Majority were Governmental and Nonprofit Organizations (NPO) (37.8%), followed by commercial Web sites (22.2%). Only 6 of the Web sites were HONcode certified. The mean DISCERN score was 53.1 (SD=9.0). The Governmental and NPO Web sites had the highest overall DISCERN scores followed closely by Physician Web sites. The mean JAMA benchmark criteria score was 2.1 (SD=1.2). Nine Web sites had maximal scores and the Academic Web sites had the highest overall JAMA benchmark scores. DISCERN scores, JAMA benchmark scores, and Perthes-specific Content scores were all greater for Web sites that bore the HONcode seal. The quality of information available online regarding Perthes disease is of variable quality. Governmental and NPO Web sites predominate and also provide higher quality content. The HONcode seal is a reliable indicator of Web site quality. Physicians should recommend the HONcode seal to their patients as a reliable indicator of Web site quality or, better yet, refer patients to sites they have personally reviewed. Supplying parents with a guide to health information on the Internet will help exclude Web sites as sources of misinformation.

Automated Detection of HONcode Website Conformity Compared to Manual Detection: An Evaluation.

BackgroundTo earn HONcode certification, a website must conform to the 8 principles of the HONcode of Conduct In the current manual process of certification, a HONcode expert assesses the candidate website using precise guidelines for each principle. In the scope of the European project KHRESMOI, the Health on the Net (HON) Foundation has developed an automated system to assist in detecting a website’s HONcode conformity. Automated assistance in conducting HONcode reviews can expedite the current time-consuming tasks of HONcode certification and ongoing surveillance. Additionally, an automated tool used as a plugin to a general search engine might help to detect health websites that respect HONcode principles but have not yet been certified.ObjectiveThe goal of this study was to determine whether the automated system is capable of performing as good as human experts for the task of identifying HONcode principles on health websites.MethodsUsing manual evaluation by HONcode senior experts as a baseline, this study compared the capability of the automated HONcode detection system to that of the HONcode senior experts. A set of 27 health-related websites were manually assessed for compliance to each of the 8 HONcode principles by senior HONcode experts. The same set of websites were processed by the automated system for HONcode compliance detection based on supervised machine learning. The results obtained by these two methods were then compared.ResultsFor the privacy criterion, the automated system obtained the same results as the human expert for 17 of 27 sites (14 true positives and 3 true negatives) without noise (0 false positives). The remaining 10 false negative instances for the privacy criterion represented tolerable behavior because it is important that all automatically detected principle conformities are accurate (ie, specificity [100%] is preferred over sensitivity [58%] for the privacy criterion). In addition, the automated system had precision of at least 75%, with a recall of more than 50% for contact details (100% precision, 69% recall), authority (85% precision, 52% recall), and reference (75% precision, 56% recall). The results also revealed issues for some criteria such as date. Changing the “document” definition (ie, using the sentence instead of whole document as a unit of classification) within the automated system resolved some but not all of them.ConclusionsStudy results indicate concordance between automated and expert manual compliance detection for authority, privacy, reference, and contact details. Results also indicate that using the same general parameters for automated detection of each criterion produces suboptimal results. Future work to configure optimal system parameters for each HONcode principle would improve results. The potential utility of integrating automated detection of HONcode conformity into future search engines is also discussed.

The quality and readability of online consumer information about gynecologic cancer.

The Internet has become an important source of health-related information for consumers, among whom younger women constitute a notable group. The aims of this study were (1) to evaluate the quality and readability of online information about gynecologic cancer using validated instruments and (2) to relate the quality of information to its readability. Using the Alexa Rank, we obtained a list of 35 Web pages providing information about 7 gynecologic malignancies. These were assessed using the Health on the Net (HON) seal of approval, the Journal of the American Medical Association (JAMA) benchmarks, and the DISCERN instrument. Flesch readability score was calculated for sections related to symptoms and signs and treatment. Less than 30% of the Web pages displayed the HON seal or achieved all JAMA benchmarks. The majority of the treatment sections were of moderate to high quality according to the DISCERN. There was no significant relationship between the presence of the HON seal and readability. Web pages achieving all JAMA benchmarks were significantly more difficult to read and understand than Web pages that missed any of the JAMA benchmarks. Treatment-related content of moderate to high quality as assessed by the DISCERN had a significantly better readability score than the low-quality content. The online information about gynecologic cancer provided by the most frequently visited Web pages is of variable quality and in general difficult to read and understand. The relationship between the quality and readability remains unclear. Health care providers should direct their patients to reliable material online because patients consider the Internet as an important source of information.

Evaluation of Health on the Net seal label and DISCERN as content quality indicators for patients seeking information about thumb sucking habit.

Aims:The aim of this study was to evaluate the reliability of websites on the thumb sucking habit using DISCERN instrument and Health on the Net (HON) seal code at a single moment in time.Subjects and Methods:An Internet search engine (www.google.com) was used to identify websites comprising information on “thumb sucking habit.” Of over 204,000 links for thumb sucking habit, the first 100 were analyzed in detail. After excluding discussion groups, news and video feeds, and removing carbon copy sites, only 36 relevant websites remained, which were then assessed using the DISCERN instrument and HON seal code. Using the 16 questions of DISCERN for assessing the reliability and quality of the consumer information which were scored from 1 to 5, an appropriate index of the quality of the information was generated. All the assessed websites were also checked for presence or absence of HON seal code.Results:The maximum score attainable for an outstanding website is 80. Of the 36 websites that were scored the highest score obtained by one of the websites according to the DISCERN tool was 55 of 80, and the lowest score achieved was 16 of 80. The websites achieving the maximum and minimum score were children.webmd.com and thebehaviorsolution.com, respectively. The HON seal was displayed only in three websites, which were medicinenet.com, righthealth.com, and children.webmd.com.Conclusions:By directing patients to validated websites on the thumb sucking habit, clinicians can ensure patients find appropriate information.

The Most Influential Scientists in the Development of Medical Informatics (8): Jean Raoul Scherrer.

Jean–Raoul Scherrer (1932 - 2002) was a pioneer in the development and deployment of clinical information systems (1, 2, 3). He received in 2000 the Morris F. Collen Award of Excellence in medical informatics. Jean-Rauol Scherrer was born in the Canton of Jura, Switzerland, in October 1932 but has lived most of his life in Geneva, Switzerland. He went to college in Fribourg, at a Jesuit School called College of Saint Michel, and followed the classical pathway - ancient Greek, Latin, and strong mathematics studies. In 1959, he graduated from the Medical School of the University of Geneva, where he studied Physiology and Internal medicine. From 1967 until 1969, Professor Scherrer did postgraduate work in Medical physics at Brookhaven National Laboratory, on Long Island, and then returned to Geneva and the Cantonal Hospital of the University of Geneva, where he began to design and build what was to become DIOGENE, the Hospital’s patient information system. The idea was to have a system that would be patient-centric. Professor Scherrer addressed the needs of the physician, and not only that, he did not encumber the physician with the need to learn the computer (1). The basic principle was : One puts orders in through the telephone. One could immediately see on the screen what he had ordered. Behind this outward facade was a bank of individuals who were keying in the information for orders, for medications, for laboratory work, and for radiology. But his objective was to see how the computer could be an enabling tool, to assist the health care provider in doing what he or she needed to do to be giving the best possible care for the patient. Starting with the mainframe-based patient-centered hospital information system DIOGENE in the 70s, Prof. Scherrer developed, implemented and evolved innovative concepts of man-machine interfaces, distributed and federated environments, leading the way with information systems that obstinately focused on the support of care providers and patients. Through a rigorous design of terminologies and ontologies, the DIOGENE data would then serve as a basis for the development of clinical research, data mining, and lead to innovative natural language processing techniques. In parallel, Prof. Scherrer supported the development of medical image management, ranging from a distributed picture archiving and communication systems (PACS) to molecular imaging of protein electrophoreses (2). Recognizing the need for improving the quality and trustworthiness of medical information on the Web, Prof. Scherrer created the Health-On-the-Net (HON) foundation. He had groups working on natural language processing and image processing and manipulation in the OSIRIS system. Another of his groups was determining protein constellations in human patients by the use of bi-dimensional electrophoresis of human serum, and correlating these patterns with the identification of genes, using several scattered remote data bases. This Web-based system is called ExPASy. This was one of the first bioinformatics groups assembled any place in the world. In Geneva in 1992, researchers at CERN, a high-energy physics laboratory, invented the World Wide Web. Luckily, the director of CERN was a neighbor of Professor Scherrer, and because of this neighborhood collaboration, the group at Geneva Hospital was really the first to apply World Wide Web technology in health care. They made their protein research databases available to colleagues around the world via the Web and were really the first to do this. Dr. Scherrer was Executive Vice President of IMIA (International Medical Informatics Association) in charge of Working Groups and Special Interest Groups from 1993 to 1996: and President of the EFMI (1996-1998) (2). Figure 1 Scherrer Jean-Raoul (1932.-2002.)