Medical Web Research Articles

POPPER, a simple programming language for probabilistic semantic inference in medicine

Our previous reports described the use of the Hyperbolic Dirac Net (HDN) as a method for probabilistic inference from medical data, and a proposed probabilistic medical Semantic Web (SW) language Q-UEL to provide that data. Rather like a traditional Bayes Net, that HDN provided estimates of joint and conditional probabilities, and was static, with no need for evolution due to “reasoning”. Use of the SW will require, however, (a) at least the semantic triple with more elaborate relations than conditional ones, as seen in use of most verbs and prepositions, and (b) rules for logical, grammatical, and definitional manipulation that can generate changes in the inference net. Here is described the simple POPPER language for medical inference. It can be automatically written by Q-UEL, or by hand. Based on studies with our medical students, it is believed that a tool like this may help in medical education and that a physician unfamiliar with SW science can understand it. It is here used to explore the considerable challenges of assigning probabilities, and not least what the meaning and utility of inference net evolution would be for a physician.

Testing and Evaluation of a Hierarchical SOAP based Medical Web Service

Performance testing of hierarchical web service communications is essential from the perspective of users as well as developers, since it directly reflects the behavior of the service. As such we have developed a SOAP based research web service, suitable for online medical services to study the performance and to evaluate the technique used for developing the service. We call the service as MedWS (prototype research medical web service). Load and stress testing have been carried out on MedWS using Mercury Load Runner to study the performance, stability, scalability and efficiency of the service. The performance depends on metrics such as hits/sec, response time, throughput, errors/s and transaction summary. These metrics are tested with different stress levels. The statistical analysis on the recorded data has been carried out to study the stability and quality of the application. The present study reveals that the SOAP based web service which has been developed with Java programming language is stable, scalable and effective. We present here the architecture, testing procedure, results of performance testing as well as the results of statistical analysis on recorded data of MedWS.

Shoplifting of Everyday Products That Serve Illicit Drug Uses

Objectives: Some everyday products, particularly over-the-counter drugs, which are sold in supermarkets and other stores can produce a “high” or serve other roles in illicit drug use. Informed by CRAVED, a model of theft choices derived from crime opportunity theory, this study explores whether products with known roles in drug use are shoplifted at higher rates than other products. Methods: Products that serve a variety of roles in illicit drug use were identified through a review of the medical literature and web sources. Data from 204 supermarkets yielded theft rates for 551 of these products, which were compared with theft rates for 7,887 products sold by the same stores without known roles in drug abuse. Results: Theft rates of products with roles in drug use were significantly higher than theft rates of other products. Conclusions: Knowing which products are shoplifted can provide only limited information about the shoplifter’s “craft.” In this case, more information was needed about the security given to products by the stores, which has broader implications for CRAVED. Despite this, the findings about the higher theft rates of products with known drug roles could assist retailers, manufacturers, and responsible government agencies to secure these products from theft.

Utility of a dermatology interest group blog: the impact of medical student interest groups and Web 2.0 tools as educational resources.

The open access University of Texas Dermatology Interest Group blog was established in 2004 for the purposes of increasing communication and collaboration between medical students and dermatology faculty, residents, and alumni, as well as to promote educational opportunities and the missions for which the interest group was created. This blog is unique because of its longevity and continuous postings directed toward the educational and professional needs of medical students and residents. A blog user survey was performed to assess viewers’ thoughts, purpose of viewing, demographic profile, subscriber status, usage of the blog and other Web 2.0 tools (forums, Facebook, blogs, Twitter, podcasts), and perceived usefulness. Sixty-one anonymous online surveys were completed during a 1-month period. Statistical analyses of the responses demonstrated that the utilization of web-based tools and the blog were valuable resources for students, especially for blog subscribers, those more involved in an interest group, and those reading the blog for a longer period of time. The usefulness and impact of this method of communication and dissemination of information in medical education may encourage other student groups, faculty advisors, and educators to implement similar educational tools at their institutions.

Interstate Equine Semen and Embryo Shipment Regulations in the United States and Their Implications on Control of Disease Transmission

Outbreaks of both equine viral arteritis and contagious equine metritis (CEM) in the United States have occurred in recent years. Shipped semen has been implicated in disease transmission and rapid spread. A survey was performed of state regulations regarding testing for equine arteritis virus (EAV) and CEM before interstate semen or embryo shipment. Results demonstrated lack of any requirements in 31 states. Four states had regulations regarding EAV; 17 required a Certificate of Veterinary Inspection (CVI) to accompany a semen or embryo shipment. Ten states required a negative equine infectious anemia test, primarily as a requirement of a CVI versus because of risk of dissemination of disease. No states required CEM testing. A comparison of state department of agriculture or veterinary medical association Web sites and direct communication with state veterinarians or their offices demonstrated contradictory information in six states. The lack of uniform regulations concerning CEM and EAV testing for shipped semen and embryos, and the threat they pose to the equine breeding industry and horse health, should be alarming to veterinarians and horse owners. Routine testing of animals before shipment of semen or embryos and veterinary involvement in collection and breeding activities are appropriate and necessary to help prevent future outbreaks and protect equine health.

Discrepancies in Health Information Found on Web sites Discussing Cures for Inflammatory Bowel Disease, an “Incurable” Disease

Inflammatory bowel disease, which can take the form of ulcerative colitis or Crohn's disease, is said by most doctors to be incurable, although surgery is sometimes considered a cure for ulcerative colitis but not Crohn's disease. Because of the unpredictable nature of the disease, however, and the devastating symptoms it can have, many people are driven to search for cures online, despite what their doctors may recommend. This qualitative content analysis looked at the top search results in Google and Bing for inflammatory bowel disease cures. We examined 63 search results returned using a variety of search terms. Search results included articles, entire Web sites, YouTube videos, health forums, and an e-book. The Web sites generally fell into 2 categories: those that said no cure exists and those that advocated for specific cures. The following themes were pulled from the data: an inconsistent definition of a cure; an anti-Western medicine bias; medical disclaimers that are ignored by Web sites that feature them; a lack of clarity in cure regimens; and inter-article contradictions. Many people with inflammatory bowel disease do not like hearing that the disease has no cure or they do not believe their doctor when told this. Medical professional Web sites often say very little about what a cure looks like or how it is defined medically. Well-meaning patients have filled this void with their own definitions of a cure. Physicians need to be aware of what information patients can find online because many patients are unwilling to share this information.

The Scholarly Merit of Social Media Use Among Clinical Faculty.

Background: Social media (SoMe) platforms such as blogs, Twitter, and Facebook are increasingly becoming incorporated into education and scientific communities. In fields such as emergency medicine, clinicians have established communication channels through SoMe to engage in academic and clinical discussions for the purposes of professional growth. While the use of SoMe as an educational tool within the classroom has been previously described, its use as a professional tool has not been adequately investigated. Objective: To assess the perception of SoMe as an academic tool among deans of accredited health care professional schools in the United States. Methods: An electronic cross-sectional survey was distributed to deans of accredited medical, nursing, and pharmacy schools across the United States to assess the knowledge of SoMe, attitudes toward academic merit, and challenges to incorporating SoMe into scholarly activity. Responses were analyzed using descriptive statistics. Results: Of 188 responses (response rate = 22%), 162 (86%) agreed publication in a peer-reviewed journal ranked highest in academic merit, followed by publishing in medical Web sites (157, 84%), publication in a university-based newsletter (147, 78%), and personal medical education blog (150, 80%). Fifty-one (31%) of respondents stated that volume of viewership would improve academic merit, while 85 (52%) believed a peer-review process would improve academic merit. Conclusion: Although professional SoMe activities should not replace traditional publications, the result of this study suggest establishing a peer-review process to improve validity of such activities.

Evaluation of Medical Journal Web Sites

In the past 10 years, most medical journals have developed Web sites that not only deliver the electronic version of their publication but also provide a multimedia collection of resources, articles, educational tools, and external links to meet the needs and interests of the 21st century clinician. This article presents an evaluation tool with 5 criteria to assess the quality and scope of a medical journal's Web site and provides readers with an assessment and detailed tour through the Web sites of 5 major medical journals.

Creating Clinical Practice Guidelines We Can Trust, Use, and Share

Standards and guidance for developing trustworthy clinical practice guidelines are now available, and a number of leading guidelines adhere to the key standards. Even current trustworthy guidelines, however, generally suffer from a cumbersome development process, suboptimal presentation formats, inefficient dissemination to clinicians at the point of care, high risk of becoming quickly outdated, and suboptimal facilitation of shared decision-making with patients. To address these limitations, we have--in our innovative research program and nonprofit organization, MAGIC (Making GRADE the Irresistible Choice)--constructed a conceptual framework and tools to facilitate the creation, dissemination, and dynamic updating of trustworthy guidelines. We have developed an online application that constitutes an authoring and publication platform that allows guideline content to be written and structured in a database, published directly on our web platform or exported in a computer-interpretable language (eg, XML) enabling dissemination through a wide range of outputs that include electronic medical record systems, web portals, and applications for smartphones/tablets. Modifications in guidelines, such as recommendation updates, will lead to automatic alterations in these outputs with minimal additional labor for guideline authors and publishers, greatly facilitating dynamic updating of guidelines. Semiautomated creation of a new generation of decision aids linked to guideline recommendations should facilitate face-to-face shared decision-making in the clinical encounter. We invite guideline organizations to partner with us (www.magicproject.org) to apply and further improve the tools for their purposes. This work will result in clinical practice guidelines that we cannot only trust, but also easily share and use.

The utility of prostate‐specific antigen in the management of advanced prostate cancer

To review current prostate-specific antigen (PSA) metrics used in monitoring treatment of advanced prostate cancer, with a specific focus on castration-resistant prostate cancer (CRPC) therapies. Explore what is known about the correlation between PSA and androgen levels as well as underlying reasons for persistent PSA expression and serum elevation in CRPC, and outline suggestions for use of PSA in managing patients with advanced prostate cancer. A comprehensive search of the PubMed database for English language articles through April 2012 was performed using the following Medical Subject Headings (MeSH) keywords or terms, alone or in combination: 'prostate cancer'; 'prostate cancer treatment'; 'prostate cancer outcomes'; 'prostate-specific antigen'; 'androgen receptor'; 'advanced prostate cancer'; 'castration-resistant prostate cancer'; 'biomarkers'. Bibliographies of relevant articles were searched for additional references. Relevant medical society and regulatory agency web sites from the USA and Europe were accessed for issued guidance on PSA use. PSA doubling time (PSADT) is a useful metric for determining which patients should be considered for androgen-deprivation therapy (ADT) after failing local treatment or for second-line therapies after failing ADT. However, it is not a validated surrogate for survival and no therapy has received regulatory approval based upon PSADT characteristics. PSA nadir and time-to-nadir have been identified as possible prognostic markers for patients receiving ADT. There is no universally accepted definition for PSA progression, nor is PSA progression a regulatory-approved surrogate for clinical progression in drug approval trials. PSA responses to second-line therapies can vary and are not considered by regulatory agencies as valid surrogates for clinical endpoints, so they must be assessed in the context of each individual therapy and trial design. PSA expression in CRPC is often a reflection of persistent androgen receptor activity. While we can provide guidance for use of PSA monitoring in managing patients with advanced prostate cancer based on the data at hand, there is an urgent need for prospective analyses of refined PSA metrics in conjunction with newer prostate cancer biomarkers in clinical trials to provide stronger evidence for their roles as surrogate endpoints.

Prevalence of autism spectrum disorders among children in China: a systematic review.

BackgroundThere are no reliable estimates of the prevalences of autism and autism spectrum disorders (ASD) in China.ObjectiveCombine results across studies to estimate the prevalences of autism and ASD among Chinese children under the age of 18, and assess variations in the prevalences with respect to gender, ethnicity, and urban versus rural residence.MethodsBased on pre-defined inclusion and exclusion criteria, studies were identified by searching the following databases: Chinese National Knowledge Infrastructure, Chongqing VIP database for Chinese Technical Periodicals, WANFANG DATA, Chinese Biological Medical Literature Database, Pubmed, and Web of Science. Statistical analysis was conducted using R-2.15.2 software.ResultsThe 24 studies meeting inclusion criteria included 5 registry studies from Taiwan and Hong Kong (covering a total of 14570 369 children) and 19 community-based screening and diagnostic studies from mainland China (with a combined sample of 771 413 children). The annually reported prevalence of autism in the registry studies ranged from 1.8 to 424.6 per 10 000. A meta-analysis of 18 of the studies from mainland China (excluding a large nationwide study with the lowest prevalence of autism) with a range in rates from 2.8 to 30.4 per 10 000 generated an estimated pooled prevalence of autism of 12.8 per 10 000 (95%CI, 9.4 to 17.5). The pooled prevalence of ASD estimated from 5 of these studies (which had a range in rates from 7.3 to 75.3 per 10 000) was 24.5 per 10000 (95%CI, 10.4 to 57.4). The reported prevalence of autism varied substantially by gender, location of residence, date of publication, and source of the sample.ConclusionThe huge difference between the rates for autism reported from registry systems in Hong Kong and Taiwan (a 200-fold difference) and the large differences in rates reported from community-based screening studies in mainland China (a 10- to 15-fold difference) highlight the urgent need for establishing standardized methods for estimating the prevalences of autism and ASD. Until these methodological improvements have been made, it will not be possible to develop evidence-based prevention and treatment strategies for the management of these uncommon but seriously disabling conditions.

Educational interventions in neurology: a comprehensive systematic review

A fear of neurology and neural sciences (neurophobia) may have clinical consequences. There is therefore a need to formulate an evidence-based approach to neurology education. A comprehensive systematic review of educational interventions in neurology was performed. BEI, Cochrane Library, Dialog Datastar, EBSCO Biomedical, EBSCO Psychology & Behavioral Sciences, EMBASE, ERIC, First Search, MDConsult, Medline, Proquest Medical Library and Web of Knowledge databases were searched for all published studies assessing interventions in neurology education among undergraduate students, junior medical doctors and residents up to and including July 2012. Two independent literature searches were performed for relevant studies, which were then classified for level of evidence using the Centre of Evidence-based Medicine criteria and four levels of Kirkpatrick educational outcomes. One systematic review, 16 randomized controlled trials (RCTs), nine non-randomized cohort/follow-up studies, 33 case series or historically controlled studies and three mechanism-based reasoning studies were identified. Educational interventions showed favourable evaluation or assessment outcomes in 15 of 16 (94%) RCTs. Very few studies measured subsequent clinical behaviour (two studies) and patient outcomes (one study). There is very little high quality evidence of demonstrably effective neurology education. However, RCTs are emerging, albeit without meeting comprehensive educational criteria. An improving evidence base in the quality of neurology education will be important to reduce neurophobia.

Analyzing web citations availability and half‐life in medical journals

PurposeThe aim of this study is to compare the situation of internet resource citations in scientific articles of the journals of Shahid Beheshti University of Medical Sciences from 2005‐2009.Design/methodology/approachThe research method is an analytical survey with webometrics and citation analysis. The internet was used as a tool for accessing articles. They are separately analyzed on the basis of journal name and publication year. The analysis is done using MATLAB and Excel software.FindingsA total of 717 articles from seven journals during five years were reviewed. Of 13,448 citations extracted, 120 internet references were found. The final results indicated that the sum of web citations is less than 1 per cent of total citations and only 52 per cent of internet citations in studied journal articles are available. The average half‐life for the medical journals is estimated to be 1.02 years.Practical implicationsTo increase the rate of URLs availability, publishers should oblige authors to utilize online archives such as WebCite to preserve expected information for all of the citations referred to in their articles.Originality/valueThis research would be valuable since it is the first that studies stability and persistence of URL domains of medical journals published in Shahid Beheshti University of Medical Sciences according to type of domain names and file extensions. Moreover, this is the first time that the half‐life for medical universities web citations is calculated.

The development of users' mental models of MedlinePlus in information searching

This study investigated the dynamic process of people constructing mental models of MedlinePlus, a medical information web space, during their interaction with the system. Thirty-eight participants participated in the study. Their mental models of MedlinePlus were measured by a concept listing protocol and an interview method at three time points: after they freely explored the system for 5min (T1), after the first search session (T2), and after the second search session (T3). The analysis revealed that participants constructed their mental models of MedlinePlus based on the schemas that they have of information-rich web spaces. The model construction process involved changes and development in three parallel dimensions: cognition, emotion, and behavior. The development is enabled and coordinated by three mental activities: assimilating new concepts, modifying existing concepts, and phasing out previously perceived concepts. Furthermore, mental model construction is not only a function of users' internal cognition, but also affected by external cognitive structures, including the system, system feedback, and tasks. Mental model construction is also a process distributed over time. The results suggested that mental models could serve as a framework for guiding user research and system design. The dynamic nature of the mental models indicated that an iterative approach needs to be adopted.

Web Science in Medicine and Healthcare

Medical social-media provide a new source of information within information gaining contexts. Facts, experiences, opinions or information on behaviour can be found in the medical web and could support a broad range of applications. The intention of this Focus Theme is to bring the existing research together and to show the possibilities, challenges and technologies for Web Science in medicine and healthcare. This editorial provides an overview on the landscape of medical social-media and their possibilities in supporting healthcare. Further, it summarizes the three papers included in this Focus Theme. The three papers of this Focus Theme consider different aspects of Web Science in medicine which are 1) detection of drug interactions from social media, 2) inferring community structures from online forums and 3) improving access to online videos through assignment of SNOMED CT terms. All three papers show the potential of medical social-media in supporting health information gathering processes from the web. However, several issues still need to be addressed in future: Methods are necessary for identifying high quality information from the medical web as well as for processing the language that is used by social media users to report about their symptoms, diseases and other health issues.

Evaluating Consumer-Oriented Web Sites for Complementary and Alternative Medicine

Consumers and healthcare professionals need to exercise caution when seeking health care information of any type on the Web, but they need to exercise even greater caution when seeking nonstandard medical advice through complementary and alternative medical (CAM) web sites. The Health on the Net (HON) Foundation certifies web sites, but CAM information seekers need to engage in their own critical appraisals in addition to seeking out sites which enjoy HON certification. The web sites of the University of Maryland Medical Center, the National Center for Complementary and Alternative Medicine, and the Mayo Clinic are evaluated as sources of information about CAM.

Delivering Deep Health Information Using Clinical Eye

This paper introduces a web-based semantic tool that provides more detailed information about a term selected by the user of a web browser, the Clinical Eye. This tool was initially designed for the medical area of cardiology, which is still controversial in terms of vocabularies. Anontology has been developed as a reference base where those different vocabularies converge. The information supplied by the tool was taken from specialized medical web pages and technical documents. It is a tool of low interference for ongoing activities, so it can be used during a clinical activity. It has been designed according to requirements raised by studies in various medical communities, which pointed the use of Internet during consultations and medical needs for deep information.

의료 웹포럼에서의 텍스트 분석을 통한 정보적 지지 및 감성적 지지 유형의 글 분류 모델

In the medical web forum, people share medical experience and information as patients and patents' families. Some people search medical information written in non-expert language and some people offer words of comport to who are suffering from diseases. Medical web forums play a role of the informative support and the emotional support. We propose the automatic classification model of articles in the medical web forum into the information support and emotional support. We extract text features of articles in web forum using text mining techniques from the perspective of linguistics and then perform supervised learning to classify texts into the information support and the emotional support types. We adopt the Support Vector Machine (SVM), Naive-Bayesian, decision tree for automatic classification. We apply the proposed model to the HealthBoards forum, which is also one of the largest and most dynamic medical web forum.

Mesh size in Lichtenstein repair: a systematic review and meta-analysis to determine the importance of mesh size

Small mesh size has been recognized as one of the factors responsible for recurrence after Lichtenstein hernia repair due to insufficient coverage or mesh shrinkage. The Lichtenstein Hernia Institute recommends a 7×15cm mesh that can be trimmed up to 2cm from the lateral side. We performed a systematic review to determine surgeons' mesh size preference for the Lichtenstein hernia repair and made a meta-analysis to determine the effect of mesh size, mesh type, and length of follow-up time on recurrence. Two medical databases, PubMed and ISI Web of Science, were systematically searched using the key word "Lichtenstein repair." All full text papers were selected. Publications mentioning mesh size were brought for further analysis. A mesh surface area of 90cm(2) was accepted as the threshold for defining the mesh as small or large. Also, a subgroup analysis for recurrence pooled proportion according to the mesh size, mesh type, and follow-up period was done. In total, 514 papers were obtained. There were no prospective or retrospective clinical studies comparing mesh size and clinical outcome. A total of 141 papers were duplicated in both databases. As a result, 373 papers were obtained. The full text was available in over 95% of papers. Only 41 (11.2%) papers discussed mesh size. In 29 studies, a mesh larger than 90cm(2) was used. The most frequently preferred commercial mesh size was 7.5×15cm. No papers mentioned the size of the mesh after trimming. There was no information about the relationship between mesh size and patient BMI. The pooled proportion in recurrence for small meshes was 0.0019 (95% confidence interval: 0.007-0.0036), favoring large meshes to decrease the chance of recurrence. Recurrence becomes more marked when follow-up period is longer than 1year (p<0.001). Heavy meshes also decreased recurrence (p=0.015). This systematic review demonstrates that the size of the mesh used in Lichtenstein hernia repair is rarely discussed in clinical studies. Papers that discuss mesh size appear to reflect a trend to comply with the latest recommendations to use larger mesh. Standard heavy meshes decrease the recurrence in hernia repair. Even though there is no evidence, it seems that large meshes decrease recurrence rates.

Head Lice Surveillance on a Deregulated OTC-Sales Market: A Study Using Web Query Data

The head louse, Pediculus humanus capitis, is an obligate ectoparasite that causes infestations of humans. Studies have demonstrated a correlation between sales figures for over-the-counter (OTC) treatment products and the number of humans with head lice. The deregulation of the Swedish pharmacy market on July 1, 2009, decreased the possibility to obtain complete sale figures and thereby the possibility to obtain yearly trends of head lice infestations. In the presented study we wanted to investigate whether web queries on head lice can be used as substitute for OTC sales figures. Via Google Insights for Search and Vårdguiden medical web site, the number of queries on “huvudlöss” (head lice) and “hårlöss” (lice in hair) were obtained. The analysis showed that both the Vårdguiden series and the Google series were statistically significant (p<0.001) when added separately, but if the Google series were already included in the model, the Vårdguiden series were not statistically significant (p = 0.5689). In conclusion, web queries can detect if there is an increase or decrease of head lice infested humans in Sweden over a period of years, and be as reliable a proxy as the OTC-sales figures.