Medical Information Search Research Articles

Acquisition of learning outcomes by students from the Medical School of the University of Barcelona (Catalonia, Spain): A student survey

Background: In 2001, in order to improve the curriculum, the medical school of the University of Barcelona began discussions aimed at defining specific learning outcomes for its medical graduates and, subsequently, evaluating the acquisition of these competencies.Aim: To report the views of our medical students regarding the extent to which they have acquired the learning outcomes previously defined by the faculty.Method: A questionnaire was administered to seventy final year students, who had finished all the course clerkships and they were asked to indicate on a Likert scale their perceived level of acquisition of each learning outcome.Results: Overall, the students report an adequate level of competency and consider themselves able to meet skills targets under supervision in eight of the eleven domains investigated. In three of the domains (patient management, medical information search skills, and decision-making skills and clinical reasoning and judgment) students regarded themselves as only partially competent. These results agree with the global course score of the students, according to the medical school assessment system.Conclusions: The results will allow us to make curricular and methodological changes in order to implement a new outcome-based curriculum.

Évaluation de l'information sur Internet destinée aux patients francophones en neuro-oncologie

Objective Internet has become the first place where patients go to when seeking information about their disease. Little is known about the type and the quality of the medical information available on French-speaking websites, especially in the field of neuro-oncology. The purpose of this study was to evaluate the quality of these sites. Materials and Methods We entered six key words " glioblastome", " méningiome", " métastase cérébrale", " neurinome de l'acoustique", " adénome à prolactine" and " lymphome primitif cérébral" into 2 different search engines and, for each key word, the first fifty websites were reviewed using the tool “DISCERN”, and with the help of two neuro-oncologists, we rated their content in terms of quality and comprehension. Results On 612 websites only 110 (18%) contained information that proved to be somewhat useful to patients. The average score for quality was 32, which is considered to be «poor». According to our scoring system, 1.8% of websites were found to be “excellent”, 11.8% “good”, 24.5% “fairly good”, 15.4% “average”, 32.7% “poor” and 13.6% “very poor”. Just over 50% of the websites were found to be clear. The study also showed that the order in which these websites were ranked in the search engine, their affiliation, their target or who financed them had little impact on quality. The websites were more likely to be of high quality if they were managed by doctors and had bibliographical references as well as a date indicating a recent website's update. Discussion and conclusion This study shows that the search for medical information on the Internet is time consuming and often disappointing: very few websites provide information that is both clear and exhaustive. However, we also found that very few websites contained information that was seriously inaccurate. Given the growing popularity of the Internet, patients could certainly benefit from a high quality French speaking website that would specialize in cerebral tumors, as well as from a neuro-oncological portal that would take them to selected websites as it would save time and would be a guarantee for quality.

Utilización de Internet como fuente de información por los pacientes de una consulta de Enfermedades Autoinmunes Sistémicas

In recent years Internet has become an important tool for medical information search, not only for physicians but also for the patients. Little is known about Internet patient's use in Spain. Our objective was to study the frequency with which patients with different chronic autoimmune diseases cared in our unit use Internet as a source of medical information, and to identify the factors associated with its use. A survey was carried out on Internet use to patients cared in a teaching hospital Systemic Autoimmune Diseases unit along three consecutive weeks. Hundred thirty-eight patients completed the questionnaire. Eighty-seven (63%) were women. Fifty-four patients (39.1%) were older than 55 years. Mean disease progression was 34.2 +/- 39.2 months. 22% of the respondents were uneducated, 39% had elementary education level; 20% had average education level, and 20% had advanced education level. Forty-two patients (30.4%) used regularly Internet for any purpose. Factors associated to Internet use for medical purposes were regular Internet use (OR: 4.6; CI: 1.1-18.8;p = 0.03), and average or advanced educational degree (advanced education: OR: 22.9; CI: 2.6-202.7; p = 0.005; average education: OR: 8.5; CI: 1.2-59.6; p = 0.03). Eighty-one patients (58.7%) expressed their need of information on quality web pages. Many patients use Internet for medical purposes in our environment and even more consider to use it in the future. It is important to be aware of this fact and facilitate information about quality web pages for interested patients.

Lumbar Disc Herniation

An original study was performed evaluating the information presented on existing web sites for the topic of lumbar disc herniation. The purpose of this study was to evaluate the type and quality of internet information available to patients on the topic of lumbar disc herniation. Our secondary objectives were to rank the identified World Wide Web sites with respect to the caliber of relevant information and to determine the propensity for secondary commercial gain by the web site sponsors. Two-thirds of the United States population "surfs" the internet. A substantial percentage of internet users search for medical information on the World Wide Web. Because no standards exist regarding the publication of medical literature on the internet, the relevant web sites vary dramatically in terms of content and quality. Misleading or inaccurate information poses a theoretical risk to patients seeking treatment for medical conditions. METHODS.: Five search terms (lumbar disc herniation, herniated nucleus pulposus, herniated disc, slipped disc, and sciatica) were entered into 5 commonly used search engines. The first 25 links displayed by each engine were evaluated for a theoretical total of 625 web sites. Each site was evaluated in terms of content, authorship, and secondary commercial gain. An information quality score of 0 to 25 points was generated for each site; a score of 20 or greater was indicative of "high-quality" content. Our search identified 169 unique web sites of which only 16 (9.5%) scored >or=20 on the information quality score; 103 (60.9%) scored <or=10. The overall mean information quality score was 9. Highest mean scores were noted for commercial corporate (13.1) and hospital-based sites (11.2). Overall, 34.3% of sites sought secondary commercial gain. Higher scoring sites were more likely to appear within the first 10 links identified by each search engine. The quality of internet information on lumbar disc herniation is variable. Less than 10% of relevant web sites were determined to be of high-quality. The vast majority of sites were of poor informational value and more than one-third sought secondary commercialgain. The rank list of high quality sites generated from ourinformational quality score should prove useful to patients seeking information on the internet pertaining to lumbar disc herniation.

Developing a Profile of Consumer Intention to Seek Out Additional Information Beyond a Doctor: The Role of Communicative and Motivation Variables

Current reports in the medical literature demonstrate increasing acknowledgment of consumer involvement in autonomous health and medical information search beyond the doctor. Although multiple studies have segmented consumers into different groups based on the different levels of patient autonomy, the literature review revealed the lack of systematic attempts at elucidating the antecedents of autonomous consumer health information search. In this article, I examine the role of health consciousness as a mediator of the relation between communicative (interpersonal, community, print, television, and Internet) factors and health information seeking.

Personal Digital Assistants (PDAs)

Personal digital assistants (PDAs) allow users to access a wide variety of electronic information and software at the point of patient care; however, 62% of the PDA users in this study indicated that they experienced multiple (one or more) barriers to their clinical PDA information retrieval. The majority of the users responded that the lack of software and the lack of PDA memory were the primary barriers. Online searches for medical information can provide immediate access for patient care, but 88% of the respondents used the PDAs for online searching less than once a week. Health science librarians have the skills to provide resources that provide free PDA software and PDA training classes to help eliminate deterrents to PDA use.

Patient use of the Internet for health care information in Switzerland.

The aim of this study was to examine for the first time the frequency of Internet use for medical purposes by patients in Switzerland. In 2001 over a period of one month, 1604 patients at 8 medical practices in Switzerland completed a self-administered questionnaire on their access to the Internet and any search for medical information using this media. The attending physician supplied the patient's diagnosis and information on the severity of the disorder motivating the visit using a separate questionnaire. 46% of the patients included in the study had a personal computer, 33% had an Internet connection and 10% used the Internet to find medical information. Age was inversely associated with the probability of having an Internet access, whereas educational level and command of the English language were factors directly associated with this. Among those patients with access to the Internet, young adults (25 to 44 years) and those with knowledge of the English language searched for medical information significantly more frequently. Furthermore, patients attending urban medical practices and those with a more severe level of disease more often sought health care information on the Internet. The proportion of patients in Switzerland who search for medical information on the Internet is similar to the rates observed in European English-speaking countries. The Internet allows patients to actively search for information concerning their own health problems but is not currently the most common source of information used by patients. Since health professionals generate, directly or indirectly, most of the medical information published on the Internet, additional research is needed to better understand patients' needs and expectations concerning medical information using this media.

Patient use of the Internet for health care information in Switzerland.

The aim of this study was to examine for the first time the frequency of Internet use for medical purposes by patients in Switzerland. In 2001 over a period of one month, 1604 patients at 8 medical practices in Switzerland completed a self-administered questionnaire on their access to the Internet and any search for medical information using this media. The attending physician supplied the patient's diagnosis and information on the severity of the disorder motivating the visit using a separate questionnaire. 46% of the patients included in the study had a personal computer, 33% had an Internet connection and 10% used the Internet to find medical information. Age was inversely associated with the probability of having an Internet access, whereas educational level and command of the English language were factors directly associated with this. Among those patients with access to the Internet, young adults (25 to 44 years) and those with knowledge of the English language searched for medical information significantly more frequently. Furthermore, patients attending urban medical practices and those with a more severe level of disease more often sought health care information on the Internet. The proportion of patients in Switzerland who search for medical information on the Internet is similar to the rates observed in European English-speaking countries. The Internet allows patients to actively search for information concerning their own health problems but is not currently the most common source of information used by patients. Since health professionals generate, directly or indirectly, most of the medical information published on the Internet, additional research is needed to better understand patients' needs and expectations concerning medical information using this media.

Patient education and the internet: do patients want us to provide them with medical web sites to learn more about their medical problems?

This study was performed to assess inner city Emergency Department (ED) patients' use of the Internet to obtain medical information, and patients' interest in being provided medical links by their ED physician to learn more about their medical condition. A convenience sample of inner city ED patients were surveyed regarding computer/Internet access, past searches for medical information, and whether they desired medical links provided with discharge paperwork. Of 328 patients completing the survey, 178 (54%) had computers, whereas 150 (46%) had access to the Internet. Seventy-nine (24%) had previously used the World Wide Web (WWW) to obtain medical information, and 26 (33%) of these reported difficulty in obtaining useful information. One hundred ninety-two (59%) were interested or very interested in being provided links to medical sites. Patients more likely to want medical links were younger, college educated, and in higher salary ranges. There was no difference in desire to be provided links based on number of past medical problems or duration of symptoms. In conclusion, almost half the inner city ED patients in this survey have Internet access and over half were interested in being provided quality medical links as a part of their discharge paperwork.

24. Evaluation of internet information regarding lumbar disc herniation

HYPOTHESIS: Two-thirds of the US population now “surfs” the internet, and a significant amount of these users search for medical information on the world wide web. The quality of this information has potential to be misleading and inaccurate, as no standards exist regarding internet publication. The purpose of this study was to evaluate the type and quality of internet information patients encounter on the topic of lumbar disc herniation. In addition, to identify the general and specific types of world wide web sites that provide the highest caliber information, as well as to determine the propensity for these web sites to seek secondary commercial gain.

医学・医薬品の情報の探し方( 医学・医薬品分野の情報発生と入手方法)

医学・医薬品の情報の探し方( 医学・医薬品分野の情報発生と入手方法)

Risk for tumor and other disease transmission by transplantation: a population-based study of unrecognized malignancies and other diseases in organ donors.

Organ donation may involve the risk of transmittal of unwanted host factors such as infections and malignancy. These may be concealed in the emergent donation process. It may be unavoidable if first observed in a donor postmortem. A number of reports on transferred cancers have been published, but quantification of the risk has never been reliably performed. We report here the first population-based analysis of unrecognized malignancies and other diseases in cadaveric or living-related donors and the possible consequences for the recipients. We compiled a cohort of all organ donors through 27 years (1969-1996) in one single kidney transplant center covering a population on one million people. This cohort was linked to the Danish Cancer Registry, the Danish National Hospital Register, and the Danish Register of Causes of Death by means of the unique personal identification number, and all cancers, diagnosis from hospital admissions, and causes of death were identified. Follow-up was to the end of 1996. A total of 626 donors (491 cadaveric and 135 living-related donors) was included in the study. Ten carcinoma in situ or dysplasia cervix uteri (by definition nonmalignant), and 13 malignant tumors (5 of these were detected in living-related donors after donation) were detected by linkage to the cancer registry. All together, 17 recipients received organs from donors with carcinoma in situ or dysplasia cervix uteri and 20 from donors with malignancies. Two recipients from organ donors with carcinoma in situ or dysplasia of the cervix uteri and two recipients from donors with malignancies had a cancer detected; however, these were likely unrelated. One died 1 year after transplantation from a melanoma transmitted from the donor. Two cadaveric donors had previous admissions for glomerulonephritis, five for pyelonephritis, five for nephrolithiasis or ureterolithiasis, four for cystitis, and one for hydronephrosis. Despite all efforts to secure a safe organ for transplantation, transmission of donor malignancy and other diseases nevertheless can happen, as is recorded many times in the literature. We have quantified the risk using the population-based cancer registry and found a risk of 8 in 626 (1.3%) for having a donor with undetected malignancy and a risk of 1 in 626 (0.2%) for transmitting a cancer. The risk for getting some transmitted glomerulonephritis is 2 in 626 (0.3%). None of the donors with cerebral malignancies transmitted any tumors to the recipients. Compared with the benefits of organ transplantation, these risks are small; however, if time allows, a search for additional medical information from registries could further minimize the risk of transmission of malignancies or other diseases. However, this requires updated, accurate, and accessible registries and legislation that allows access to personal data and transmission of such data across administrative borders.

Patient education on the internet: opportunities and pitfalls.

The Internet, an increasingly pervasive part of our culture, has vastly increased the rate at which information is disseminated. Unfortunately, a substantial portion of medical information on the Internet is false or misleading. Realizing this, many patients would like their physicians to help guide their online searches for medical information, but most physicians do not feel comfortable enough with the Internet to provide this service. A recent poll by Cyberdialogue (2000) found that 70% of all patients would like their physicians to recommend a health care web site for their condition, but that only 4% of patients receive such a recommendation. In recommending medical web sites, physicians need to consider the quality of the web site, the quality of the content, and especially the ethics of the site. The most important ethical standard a web site must meet is the clear separation of its editorial comment from promotional material. Patients do not have enough knowledge to distinguish unbiased information from information designed to push a product or service. There are organizations such as the Health on the Net Foundation and the E-Health Code of Ethics that have established clear quality and ethical criteria, but very few resources exist for these organizations to use in policing the sites that claim to adhere to their criteria. The National Institutes of Health recently started a consumer web site (www.medlineplus.gov) that takes web sites that adhere to their stringent criteria and places them on their web site, thus ensuring proper compliance. Patient education from sources other than face-to-face contact with a physician should be seen as an adjunct to the medical practice of physicians, and not as competition. Information is a form of therapy, and should lead to better referrals, more realistic outcome expectations, better treatment compliance, and better outcomes. As long as patients are referred to information that is unbiased, well-written, and not proprietary, their decision making should be enhanced, bringing them into the decision-making loop. This allows the patient to be much more involved with his or her care. As the medical profession changes from a "gatekeeper" model to a patient choice model, patient education will take on a much greater role.

PaSent--the patient's personal health adviser.

We have attempted to automate the search for medical information that is relevant to a patient s electronic record. We used anonymous medical reports sent from the University Hospital of Tromsø to general practitioners as input data. The medical reports were matched against the NEL, a Web-based medical dictionary and document collection service for general practitioners. We evaluated only the three top-scoring documents automatically selected by the system. A medical professional evaluated whether a selected document from the NEL was very relevant to the contents of the input report, relevant or irrelevant. Initial tests showed that 60% of the top three selected documents found by the PaSent system were very relevant or relevant to the contents of the medical report used as input data. Our preliminary conclusion is that automatic location of relevant information is possible using medical reports as input data.

Use of the Web for medical information by a gastroenterology clinic population.

Surveys have shown that 60 million persons in the United States searched for health information online in 1998. However, lack of sampling from a clinic population limits the generalizability of these surveys to clinical practice. To determine gastroenterology patients' access to and use of the Web as a medical information resource, to identify for what information patients search, and to determine how often physicians recommend that patients search the Web. Cross-sectional survey of 1006 gastroenterology outpatients in Durham, NC, and Rockford, Ill, conducted in August 1999. Patient characteristics and education level, access to the Web, use of the Web as a medical information resource, search methods, and plans for future Web use. A total of 924 patients (92%) completed the questionnaire. Median age was 53 years, 41% were men, and the median education level was having completed some college. Fifty percent (462/924) reported having access to the Web. Of the 462 with access, 235 (51%) had searched the Web for medical information within the previous 12 months. Therefore, 25.5% of all patients surveyed had searched the Web for medical information within the previous year. Sixty percent of patients intended to use the Web as a medical information resource in the future. Only 35 (4%) of 825 had ever been referred to the Web by a physician. In this clinic setting, more than one quarter of gastroenterology outpatients reported having obtained medical information from the Web within the previous year. More than two thirds of patients stated they would use the Web as a medical information resource in the future. JAMA. 2000;284:1962-1964.

Hunger Strikes: Preventing Harm to Students

When the health center encountered a student hunger strike, an initial search for medical information regarding fasting provided very little on which to build management decisions. The result of a more thorough evaluation of starvation literature is presented, along with survey responses from students who fasted. Starvation may produce many adverse events, including death. Yet, according to reports, acaloric fasts that include full water intake seem to be readily tolerated for 2 weeks in young, healthy adults. Our students included juice, sports drinks, and vitamins in their diets and completed their strike without major problems. Supplementation with carbohydrates and vitamins may improve the safety or comfort of a hunger striker, but clear proof of this effect does not exist.

Clinical Reasoning of Occupational Therapists during the Initial Assessment of Physically Disabled Patients

Clinical reasoning lies at the core of the occupational therapy process. Although several models of clinical thinking have been presented in the literature for use by occupational therapists, no empirical studies have been conducted to examine the process in action. This article reports a pilot study of the first component of the occupational therapy process—assessment. Ten therapists, working with patients with physical problems in medical settings, were observed and interviewed as they assessed patients and summarized their impressions. The aim of the study was to describe the reasoning process used to determine functional problems and treatment goals. A six-stage model to describe the reasoning process was derived from the data. The first stage involved a search for medical information and led to the second stage in which assessments were selected. In stages three through six, the assessment plan was implemented, client problems were defined, treatment objectives were specified, and the assessment process was evaluated. The salient features of each stage are described. Overall, the therapists found it difficult to outline the progression of their thoughts. The medical diagnosis played a key role in their thoughts as did the therapist-patient relationship. The therapists' perspective for assessment focused on musculoskeletal and self-care functions. The data were interpreted in the light of the present status of occupational therapy theory.