Free to visit all hours

Helping patients keep in touch with relatives and friends is the objective of justvisiting.com, a website being piloted in Gateshead.

Development and evaluation of a Health Record Online Submission Tool (HOST)

INTRODUCTION

Health records (HRs) are crucial to quality patient care. The Michigan State University College of Human Medicine begins teaching health record (HR) writing during the second-year clinical skills courses. Prior to this project, we used a cumbersome paper system to allow graduate assistants to grade and give feedback on students' HRs. This study discusses the development and evaluates the effectiveness of the new Health Record Online Submission Tool (HOST).

METHODS

We developed an electronic submission system with the goals of decreasing the logistical demands of the paper-based system; improving the effectiveness, consistency, and oversight of HR instruction and evaluation; expanding the number of students who could serve as written record graduate assistants (WRGAs); and to begin preparing students for the use of electronic health records (EHRs). We developed the initial web-based system in 2003 and upgraded it to its present form, HOST, in 2007. We evaluated the system using course evaluations, surveys of WRGAs and clinical students, and queries of course faculty and staff.

RESULTS

Course evaluation by 1,106 students during years 2001 through 2008 revealed that the students' self-assessment of ability to write HRs improved briefly with the introduction of HOST but then returned to baseline. The initial change to electronic submission was well received, though with continued use its rating dropped. A survey of 65 (response rate 61.3%) clinical students indicated that HOST did not completely prepare them for EHRs. The WRGAs (n = 14; response rate 58%) found the system easy to use to give feedback to students. Faculty (n = 3) and staff (n = 2) found that it saved time and made the review of students' HRs and WRGAs grading simpler. Student perception of grading consistency did not improve.

CONCLUSIONS

HOST is the first published online method of in-depth HR training for preclinical students using information gathered in clinical encounters. With it we were able to maintain effective instruction, streamline course management, and significantly decrease staff time. HOST did not improve student perception of grading consistency and did not prepare students for specific EHR use. Within the context of our class size expansion and our community-based educational program, HOST bridges geography and can support future improvements in HR instruction and faculty development. Medical educators at other institutions could use a similar system to accomplish these goals.

Making the link. Interview by Mary-Claire Mason

An interactive website will bring together nurses in an NHS trust and the independent sector to share best practice.

Engaging the masses

The past couple of months have seen Australia gripped by election fever, with political parties and advocacy groups jostling to capture as many potential voters as possible. One factor of interest in an otherwise bland election campaign was the emergence of internet based social media tools, such as Facebook, twitter, text messaging, email advocacy, and online videos such as YouTube, as new ways of reaching out to voters like never before.

Standard care and telecare services: comparing the effectiveness of two service systems with consumers with intellectual disabilities

BACKGROUND

Onsite standard care and remote telecare supports were provided to adults with intellectual disabilities living in integrated community settings and evaluated in terms of effectiveness as consumers completed a series of novel household activities.

METHODS

Using an alternating treatment design with baseline and follow-up conditions in this single-case study, investigators compared the prompting effectiveness provided by onsite standard care staff and a remote telecare provider.

RESULTS

While both types of supports resulted in consumers completing tasks, results indicated consumers achieved slightly more independence when prompted by the telecare support provider. Additionally, telecare supports resulted in greater duration for task completion per consumer.

CONCLUSIONS

Although consumers completed tasks with greater independence using telecare supports, caution should be used when interpreting results due to the small number of participants. The potential for this technology certainly exists in supporting consumers in their own homes thus, suggestions for future investigations are provided.

Theory-based evaluation of an online cancer fatigue class

Fatigue is a common problem faced by cancer patients and survivors, yet is often overlooked. An online fatigue class is evaluated using measures based on the Health Belief Model (HBM). A sample of 26 survivors and seven caregivers completed pre-class and post-class surveys and a facilitated discussion. Statistically significant improvements were detected in both the fatigue knowledge (p < 0.001) and belief (p < 0.001) scores. Participants reported that the content was accessible and useful. The class had a positive impact on their knowledge and beliefs about cancer fatigue. This suggests that HBM may be an appropriate framework for the evaluation of Internet-based educational interventions.

The pedagogy of Momus technologies: Facebook, privacy, and online intimacy

Through cable and wireless connections at home and at work, through Wi-Fi networks and wireless spots in hotels, coffee shops, and town squares, we are indeed connected to each other. But what is the phenomenology of this connection? Technologies of expression such as Facebook, MySpace, Twitter, and other social networking technologies increasingly become like Momus windows of Greek mythology, revealing one's innermost thoughts for all to see. They give access to what used to be personal, secret, and hidden in the lives of its users, especially the young. In this article I explore the pedagogy of Momus effects of social networking technologies in the way they may alter young people's experience of privacy, secrecy, solitude, and intimacy. In addition, I examine the forms of contact afforded by instant messaging and texting on wireless mobile technologies such as the cell phone (and its wireless hybrids) for the way young people are and stay in touch with each other, and how intimacies and inner lives are attended to.

Nursing students' perception of a Web-based intervention to support learning

Tailoring information to the needs of the learner is an important strategy in contemporary education settings. Web-based learning support, informed by multimedia theory, comprising interactive quizzes, glossaries with audio, short narrated Power Point(R) presentations, animations and digitised video clips were introduced in a first year Bachelor of Nursing biological sciences subject at a university in metropolitan Sydney. All students enrolled in this unit were invited to obtain access to the site and the number of hits to the site was recorded using the student tracking facility available on WebCT, an online course delivery tool adopted widely by many educational institutions and used in this study. Eighty-five percent of students enrolled in the subject accessed the learning support site. Students' perception of the value of a learning support site was assessed using a web-based survey. The survey was completed by 123 participants, representing a response rate of 22%. Three themes emerged from the qualitative data concerning nursing students' perception of the web-based activities: 'enhances my learning', 'study at my own pace', and 'about the activities: what I really liked/disliked'. Web-based interventions, supplementing a traditionally presented nursing science course were perceived by students to be beneficial in both learning and language development. Although students value interactive, multimedia learning they were not ready to completely abandon traditional modes of learning including face-to-face lectures. The findings of this study contribute to an understanding of how web-based resources can be best used to support students' learning in bioscience.

Factors that affect implementation of web-based faculty evaluation forms: residents' perspectives from a developing country

CONTEXT

A web-based evaluation system for residents to provide feedback on faculty was piloted in four training programs at the Aga Khan University prior to institution-wide implementation. Of the four programs, less than 50% of forms were submitted by residents of three programs while more than 70% of forms were submitted by the residents of one program. This study was conducted to identify reasons for the varying participation rates of the four programs with a view to improving the system.

METHODS

A qualitative approach was employed using focus group discussions (FGDs). Volunteers were invited and three groups of eight to ten residents each were formed. Participants for FGDs were selected from all residency years. FGDs were used to identify residents' perceptions regarding the web-based faculty evaluation system and to identify residents' problems and concerns with completing the web-based faculty evaluating forms.

RESULTS

Technical issues in completing and submitting the forms online were identified to be the main deterrents to completing the evaluation forms. Non-accessibility of a resource person for resolving technical problems with the software and the burden of taking time out to complete the forms were considered as limiting factors by many residents. Residents recommended a focused orientation session to the new system within the departments.

CONCLUSION

Residents' confidence and support are key to promoting adequate participation in web-based evaluations. Focused orientation sessions, reinforcement, reminders, assurances of confidentiality, and removal of technical glitches should help to improve resident participation.

Online health information seeking in the context of the medical consultation in Switzerland

A growing number of patients search for medical information on the Internet. Understanding how they use the Internet is important, as this might impact their health, patient-practitioner roles, and general health care provision. In this article, we illustrate the motives of online health information seeking in the context of the doctor-patient relationship in Switzerland. We conducted semistructured interviews with patients who searched for health information online before or after a medical consultation. Findings suggest that patients searched for health information online to achieve the goals of preparing for the consultation, complementing it, validating it, and/or challenging its outcome. The initial motivations for online health information seeking are identified in the needs for acknowledgment, reduction of uncertainty, and perspective. Searching health information online was also encouraged by personal and contextual factors, that is, a person's sense of self-responsibility and the opportunity to use the Internet. Based on these results, we argue that online health information seeking is less concerned with what happens during the consultation than with what happens before or after it, in the sociocultural context.

Promoting evidence-based practice and translational research

Evidence-based practice (EBP) is an evolutionary step in the nursing model of excellence in professional practice at the Hospital of the University of Pennsylvania. A healthcare culture focused on excellence and world-class patient care requires that nursing research and EBP are integrated into the professional practice model and nursing care delivery. To achieve this, it requires the development of staff expertise, time allocation for staff to participate in scholarly activities, resources that support EBP and research, and expert consultants in EBP and nursing translational research. This article describes the systems and structures in place to provide staff with resources in order to translate research and deliver EBP and the multiple initiatives in disseminating evidence to the point of care.

Enhancement of care through self-monitoring and tailored feedback via text messaging and their use in the treatment of childhood overweight

OBJECTIVE

This paper first illustrates the general potential of the short message service (SMS) for symptom and behavior monitoring and the provision of tailored feedback. Second, an SMS-based maintenance treatment (SMSMT) is introduced aimed at enhancing the treatment of childhood overweight.

METHODS

After a 12-week cognitive behavioral group treatment (CBGT), 40 children were assigned to the SMSMT for a period of 36 weeks. Children were asked to send weekly self-monitoring data on eating behavior, exercise behavior, and emotions and received tailored feedback. The adherence to SMSMT and changes in Body Mass Index Standard Deviation Scores (BMI-SDS) during the first and second treatment phase were analysed.

RESULTS

Children (mean age=10.05, SD=1.28) submitted 67% of the weekly SMS that they were expected to send in. During CBGT a significant reduction by 0.20 BMI-SDS was observed. The reduction by 0.07 BMI-SDS during the SMSMT did not reach statistical significance.

CONCLUSION

The results support the feasibility of SMSMT in the treatment of childhood overweight. The efficacy of the intervention needs to be demonstrated in an RCT.

PRACTICE IMPLICATIONS

SMSMT is a promising intervention that may extend the reach of treatment centers for childhood overweight at reasonable cost and effort.

Strategies to teach family assessment and intervention through an online international curriculum

A Web-based certificate program for international health professionals to acquire understanding of family health and strategies to implement culturally sensitive health care of families is outlined. In four Web courses and a project, students progress interactively to apply culture, family, and interdisciplinary health system theories to assessments and clinical interventions with families in the interdisciplinary setting. Four online educational strategies to facilitate student success from the virtual classroom to actual clinical care are described: adjusting to the technology, communicating the learning progress openly, giving mutual feedback, and implementing evidence-based family care. Outcomes addressing student learning and skill enhancement, family interaction, and student and faculty experiences in the virtual learning environment are explored. Overall, students learned to work successfully with families in health care, experienced increasing comfort and competency in challenging situations, introduced family care in their work setting, and emerged as leaders while working in interdisciplinary teams.

Community service

Social networking websites were popular even before the advent of Facebook and Twitter. One such site is www.networks.nhs.uk

Field synopsis and synthesis of genetic association studies in osteoarthritis: the CUMAGAS-OSTEO information system

A comprehensive and systematic assessment of the current status of genetic association studies (GAS) for osteoarthritis was conducted. Data from 327 GAS involving 187 distinct genetic variants were analyzed and cataloged in CUMAGAS-OSTEO, a Web-based information system (http://biomath.med.uth.gr) that allows the retrieval and synthesis of data from GAS on osteoarthritis. In individual studies, 66 variants (mostly single nucleotide polymorphisms) showed significant associations with osteoarthritis risk. For 19 variants, the association was significant at P < 0.01, with an increased risk greater than 30%. Only 2.4% of studies had statistical power greater than 50% to detect a modest genetic effect. Nineteen variants were investigated by 4 or more studies, and their results were subjected to meta-analysis. Significant associations were derived for 2 variants (GDF5 rs143383, LRCH1 rs912428) in the main meta-analysis and for 2 other variants (TXNDC3 rs4720262, ESR1 rs2234693) in subgroup analysis by ethnicity or osteoarthritic body site. Heterogeneity ranged from none to high. In general, there was consistency of genetic effects across ethnic groups and body sites, and there was no differential magnitude of effect in large studies versus small studies. CUMAGAS-OSTEO may be a useful tool for identifying pertinent gene-osteoarthritis associations and providing an updated summary of risk effects.

Technologies enable seniors to age in place

As seniors around the world live longer, governments, third-party payers, and healthcare leaders can be found embracing the concept of aging in place. Technological advances continue to enable seniors' desire to live independently; however, seniors' diminishing capabilities require taking a fresh approach to the term user friendly. Concerted efforts in the United States, the United Kingdom, and Finland illustrate what can be done to create a higher quality of independent life for seniors aging in place.

Group dynamics and social interaction in a South Asian online learning forum for faculty development of medical teachers

BACKGROUND

Group dynamics of online medical faculty development programs have not been analyzed and reported in literature. Knowledge of the types of content of posted messages will help to understand group dynamics and promote participation in an asynchronous learning environment. This paper assesses group dynamics and social interactivity in an online learning environment for medical teachers in the South Asian context.

METHODS

Participants of a medical education fellowship program conducted by the Foundation for Advancement of International Medical Education and Research (FAIMER) Regional Institute at Christian Medical College, Ludhiana (CMCL) in India interact on a listserv called the Mentoring-Learning Web (ML-Web). Monthly topics for online discussion are chosen by fellows through a standard tool called "multi-voting". Fellows volunteer to moderate sessions and direct the pace of the discussion. We analyzed the content and process of the discussion of one particular month. The emails were categorized as those that reflected cognitive presence (dealing with construction and exploration of knowledge), teacher presence (dealing with instructional material and learning resources), and social presence, or were administrative in nature. Social emails were further classified as: affective, cohesive and interactive.

RESULTS

Social emails constituted one-third of the total emails. Another one-quarter of the emails dealt with sharing of resources and teacher presence, while cognitive emails comprised 36.2% of the total. More than half of the social emails were affective, while a little less than one-third were cohesive.

CONCLUSION

Social posts are an inevitable part of online learning. These posts promote bonding between learners and contribute to better interaction and collaboration in online learning. Moderators should be aware of their presence and use them as tools to promote interactivity.

The potential dual use of online pharmacies

The technological advances of the 20th century resulted in the creation of the Internet and its introduction into everyday life on a global scale. The Internet provides access to information and the sale and purchase of goods. Medications are also subject to trade. Their sale is conducted by online pharmacies and their global turnover amounts to hundreds of billions of dollars. Medications ordered over the Internet are sent by mail all over the world. Considering the events of recent years, we cannot exclude the risk of a terrorist attack through online pharmacies. Terrorists can establish such companies, legally or illegally, or acquire ones already existing. Parcels, which are highly trusted by the customers of online pharmacies, can, for example, be contaminated with dangerous materials. The sale of online medications in the international system is potentially dangerous and requires international regulation.

Keeping learning central: a model for implementing emerging technologies

FELT PROBLEM: Technology integration continues to be a challenge for health science faculty. While students expect emerging technologies to be used in the classroom, faculty members desire a strategic process to incorporate technology for the students' benefit. OUR SOLUTION: We have developed a model that provides faculty a strategy for integrating emerging technologies into the classroom. The model is grounded in student learning and may be applied to any technology. We present the model alongside examples from faculty who have used it to incorporate technology into their health sciences classrooms.

Implementing online tools and resources to help nurses apply evidence based care

While nurses maybe aware of tools and resources for quality improvement, this does not necessarily mean they are used in practice. An alliance between NHS Quality Improvement Scotland and The Joanna Briggs Institute in Australia has been set up to promote and facilitate the use of online tools and resources to support the development of practice and, ultimately, to enhance care. This article summarises the tools available and discusses the implementation and evaluation of this project.

Integration of cognitive and physical training in a smart home environment for the elderly people

Our research work is towards a service that can support senior citizens towards their independent living and active ageing. As it is suggested, physical and cognitive exercise training can contribute to a significant prolongation of personal autonomy and participation in society across prevailing age-related impairments such as cognitive decline. In the current paper, the approach of combination of both physical and cognitive training--adopted by LLM project--is discussed related to other similar projects that have taken place in the area of elderly home care and training. The aim of this work is to describe the technical design details of the integration process of the LLM service, which is based on a Web service architecture and to discuss alternative interface elements to be included in the LLM platform in terms of enabling user accessibility and acceptance.

An open repositories network development for medical teaching resources

The lack of interoperability between repositories of heterogeneous and geographically widespread data is an obstacle to the diffusion, sharing and reutilization of those data. We present the development of an open repositories network taking into account both the syntactic and semantic interoperability of the different repositories and based on international standards in this field. The network is used by the medical community in France for the diffusion and sharing of digital teaching resources. The syntactic interoperability of the repositories is managed using the OAI-PMH protocol for the exchange of metadata describing the resources. Semantic interoperability is based, on one hand, on the LOM standard for the description of resources and on MESH for the indexing of the latter and, on the other hand, on semantic interoperability management designed to optimize compliance with standards and the quality of the metadata.

Online resources for pediatric home care clinicians

Pediatric home care clinicians dealing with premature infants can encounter any number of unusual conditions related to their patient's prematurity. Finding reliable information on the condition can be difficult for a clinician who does not have immediate access to a health sciences library. There are, however, many useful, reliable websites that can be consulted with a laptop that has wireless access. This article reviews a variety of useful websites with a wealth of evidence-based information. The author also provides information on Health on the Net (HON), a nongovernmental, nonprofit organization that has established a code of conduct that websites must meet in order to display their seal.

Teaching medical professionals online: a cross-discipline experience

BACKGROUND

Teaching online and cross-discipline teaching are new experiences for many instructors.

AIM

Our aim was to solicit the experiences of a group of College of Education faculty about teaching medical professionals in an online master's degree in education program.

METHOD

We used a focus group approach (eight instructors) to explore and gain a deeper understanding about teaching medical professionals by instructors who are in cross disciplines (e.g., nonmedical backgrounds).

RESULTS

The data were analyzed using a qualitative thematic analysis approach. Six themes emerged from the instructors' comments about online teaching to medical professionals compared with other students they have taught in a classroom setting.

CONCLUSION

This study has implications for online teachers and for those who are planning cross-discipline teaching programs.

Baby lifecheck--is it a public health initiative?

As part of its policy to reduce health equalities and make child health a priority, the Government has introduced a free, nationally-available online NHS health promotion tool called Baby LifeCheck. Targeted at parents and carers of babies aged 5-8 months, it provides information and advice to help parents make positive changes to improve their child's long-term health outcomes. Research had suggested that parents of babies aged 5-8 months often felt isolated and had questions or worries about their child's development and about feeding, sleep and safety. Users follow a programme consisting of.a confidential lifestyle questionnaire, feedback on the results and suggestions for change and improvement, with links to sources of support and further information. The numbers of people using the Baby LifeCheck website has exceeded targets, but feedback from Netmums, a large online support network for parents, is that their members find the website simplistic, patronising and unnecessary.This article suggests that while Baby LifeCheck is in some respects a usable tool in the context of health promotion, it falls short of being a public health initiative. It is only likely to be used by those who are computer-literate and already motivated to invest in their child's health and well-being. Public health initiatives require collaborative working between agencies. They also require practitioners as well as tools. If one is available without the other, outcomes are likely to be inadequate.

Preimplantation genetic diagnosis on in vitro fertilization clinic websites: presentations of risks, benefits and other information

OBJECTIVE

To examine information on preimplantation genetic diagnosis (PGD) presented on IVF clinic websites.

DESIGN

We systematically sampled every third IVF clinic on the 2004 Centers for Disease Control provider list.

SETTING

The Internet.

PATIENT(S)

None.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Benefits, risks, and other types of information mentioned regarding PGD.

RESULT(S)

Of 135 sites examined, 88.1% had websites, and 70% mentioned PGD, of which 27% were university- or hospital-based and 63% were private clinics. Sites mentioning PGD listed uses and benefits of PGD far more than the risks involved. Of these sites, 76% described testing for single-gene diseases, but fewer mentioned risks of missing target diagnoses (35%) or risks for loss of embryo (18%), and 14% described PGD as new or controversial. Private clinics were more likely than other programs to be on either the East or West Coast, list certain PGD risks (e.g., diagnostic error), note that PGD was new or controversial, reference source of PGD information, provide accuracy rates of genetic testing of embryos, and offer gender selection for social reasons.

CONCLUSION(S)

Most IVF clinics advertise PGD online, but the scope and quality of information about it varies widely, emphasizing benefits while minimizing risks. Clinics and patients may benefit from more thorough and consistent presentation of PGD, drawing on available evidence to best provide a realistic portrayal of PGD.

Information on nutrition and eye health

New American Optometric Association materials can assist optometrists in helping patients understand the importance of good nutrition. A growing number of Web-based services offers nutrition information that may be interesting to both patients and practitioners.