Utilization of a paediatric link collection by health professionals and laypersons

Self-reported treatment patterns in patients with Sturge-Weber syndrome and migraines

Migraine is common in patients with Sturge-Weber syndrome, yet treatment options are poorly described. An Internet-based questionnaire was completed anonymously by 104 Sturge-Weber syndrome patients, 74 of whom reported experiencing migraines (median age, 25 years; range, 3-64 years). Sixteen (22%) subjects self-reported trying triptans. Five of 12 (42%) describing triptan response believed they were very efficacious (median time of onset of 26 minutes), compared to 13 of 65 (20%) using over-the-counter analgesics (P = .08). Eighty-eight percent (14/16) of triptan users self-reported that when they do not use medications, migraines had a moderate to severe impact on their quality of life; however, while taking triptans, only 50% (7/14) of users reported such an impact (P = .03). Two patients using triptans reported transient unilateral weakness. Of the 26 patients (35%) who received daily preventative medications, 80% experienced improved quality of life. In addition, only 10 of 24 (42%) reported a significant negative impact of migraines on quality of life with daily preventative use, compared to 22 of 26 (85%) without their use (P = .002). Sturge-Weber syndrome patients with migraines are using triptans and preventative agents and self-reporting good efficacy. The small sample size precludes any safety analysis, however, and future prospective trials of both treatment options are needed.

Information literacy-what it is about? Literature review of the concept and the context

OBJECTIVES

The use of IT in health care has merged advanced knowledge and skills for health care professionals. Former studies indicate that basic skills in computer use are no more than comprehensive competencies to manage electronically stored information in health care. The purpose of this paper is to review the literature focusing on the concept information literacy in the field of health, nursing and medical informatics. The target is to find out how information literacy is defined, in what kind of context it is presented and who are the focus of interest.

METHODS

An automated literature search was performed on-line to Medline and by using the EndNote Bibliographic Software. All together the number of papers analyzed was 97 or 78% of the total literature search result.

RESULTS

The survey indicates that the concept information literacy does not exist as such in the literature, but it can be found as a synonym to 'computer literacy' or even more obscure concepts such as 'informatics awareness' or 'computer experience'. The definitions of these concepts varied considerably. A variety of descriptions of educational programs were also found, none were based on the IMIA recommendations.

CONCLUSIONS

In international cooperation such as that of IMIA WG1, a wide range of efforts still needs to be carried out to compile educational programmes in health informatics to enhance knowledge and skills in computer use among health care professionals.

A pediatric surgery study: parent usage of the Internet for medical information

PURPOSE

The goal of this study was to (1) determine parents access to and use of the Internet for information relating to their child's health; (2) investigate parents methods of searching for such information; and (3) evaluate the information found in relation to its readability, accuracy, and influence.

METHODS

A study was conducted of 150 parents of outpatients in the Pediatric Surgery Clinic of a local Children's Hospital. Parents completed study surveys over a 6-week time frame.

RESULTS

All parents (150 of 150, 100%) completed the surveys. The median age of the parents was 35 years, 83% (124 of 150) were mothers, and most (32%) attained a high school diploma. Of the 128 parents having Internet access, 71% used the Internet to search for health-related information. A majority of parents, 98%, agreed or somewhat agreed that the information they found was comprehensible and helpful. All respondents at least somewhat trusted information found, and 52% were at least somewhat influenced by online information when making a medical decision.

CONCLUSIONS

Many parents use the Internet for additional medical information, but they do not access this information frequently. The overwhelmingly positive impression of online health information suggests parents are unaware of the dangers of encountering misleading sources, an issue of special concern when considering the amount of influence this information carries. A movement must be made to create uniform guidelines for health information on the Internet. In the meantime, pediatric surgeons must take a role in guiding parents toward accurate online sources and becoming more Internet proficient themselves.

Secure medical digital libraries

In this paper, a secure medical digital library is presented. It is based on the CORBA specifications for distributed systems. The described approach relies on a three-tier architecture. Interaction between the medical digital library and its users is achieved through a Web server. The choice of employing Web technology for the dissemination of medical data has many advantages compared to older approaches, but also poses extra requirements that need to be fulfilled. Thus, special attention is paid to the distinguished nature of such medical data, whose integrity and confidentiality should be preserved at all costs. This is achieved through the employment of Trusted Third Parties (TTP) technology for the support of the required security services. Additionally, the proposed digital library employs smartcards for the management of the various security tokens that are used from the above services.

Evaluation of pediatric surgery information on the Internet

BACKGROUND/PURPOSE

Increasing numbers of parents use the Internet to obtain information about their child's medical diagnosis. Unfortunately, this information is not screened or regulated. The authors sought to evaluate the information available on the Internet regarding intersex anomalies as a representative pediatric surgical diagnosis.

METHODS

Six search engines were searched for ambiguous genitalia. The first 30 sites on each search engine were reviewed. Sites were reviewed to identify information that did not conform to accepted recommendations for evaluation and treatment.

RESULTS

Searches for ambiguous genitalia and synonyms found 0 to 44,471 sites per search engine. Of the 300 sites reviewed, only 45 represented 8 unique sites offering medical information. Five of these sites conformed to recommendations in 2 standard pediatric surgery texts, whereas 3 offered misleading information or information that did not conform to text recommendations. Of the total 300 sites, only 5 (1.6%) of accessible pages offered appropriate medical information to parents.

CONCLUSIONS

Parent-oriented information regarding intersex anomalies is difficult to find on the Internet. Over one third of sites containing medical information failed to conform to standard pediatric surgical recommendations for treatment. Pediatric surgeons should help parents effectively use Internet information.

Pediatric surgery on the Internet: is the truth out there?

BACKGROUND

The enormous amount of unmonitored medical information on the Internet prompted this investigation into the quality of pediatric surgery information on the Internet.

METHODS

The Internet was searched for information on diaphragmatic hernia (CDH), abdominal wall defects (AWD), pediatric inguinal hernia (IH), and pectus excavatum (PE). Websites were characterized, classified, and evaluated for completeness, accuracy and bias toward or against the medical profession.

RESULTS

A total of 141 websites were evaluated (N(CDH) = 37, N(AWD) = 49, N(IH) = 26, N(PE) = 29). A total of 59.6% targeted medical professionals, and 46.8% targeted the lay population. A total of 58.2% described symptoms and diagnosis. Etiology, pathology, surgery, postoperative course, and prognosis each were addressed by under 40%. A total of 58.2% were accountable for the information presented. A total of 93.1% were incomplete, 75.7% contained accurate information, and 97.7% were positive or neutral toward medical treatment. Among diagnoses, CDH had the highest percentage of websites owned by academic institutions. PE had the highest percentage of websites owned by lay people. PE websites also were the least accurate.

CONCLUSIONS

Internet information on pediatric surgery varies significantly in quality. Lay people own most websites targeted at the lay audience, and the information may not reflect the opinions of most pediatric surgeons. Increasing use of the Internet by parents seeking medical information warrants an organized approach to ensure complete and accurate information online.

Improving usage of pediatric information on the Internet: the Virtual Children's Hospital

OBJECTIVE

Digital health sciences libraries (DHSLs) bring order to the chaos of the Internet by making authoritative medical information easily and conveniently available to patrons. The goal of this project was to perform a baseline usage analysis of the pediatric-related information in a general DHSL and to determine whether reorganization of the pediatric-related information into its own pediatric DHSL could increase the usage of the pediatric-related information.

METHODS

From March through August 1997, a baseline analysis of a general DHSL (Virtual Hospital) was conducted using computer server log file analysis programs. The quantity of pediatric-related information in the general DHSL and its baseline usage were determined. In September 1997, the pediatric-related information was reorganized into its own pediatric DHSL (Virtual Children's Hospital), and server log file analyses were conducted of the pediatric DHSL from September 1997 to August 1998. Statistical analysis was performed by time series autoregression.

RESULTS

During the baseline, the general DHSL and the pediatric-related information received a monthly average of 2 320 782 and 141 444 qualified hits, respectively. After the intervention, the general DHSL and the pediatric DHSL received a monthly average of 2 765 454 and 256 998 qualified hits, respectively. This is an increase of 19. 2% for the general DHSL and 81.7% for the pediatric DHSL. These changes were statistically significant at the P >.0001 level. The most requested pediatric-related content in the pediatric DHSL did not change substantively from preintervention to postintervention.

DISCUSSION

On the Internet, as in real life, children's services must have their own distinct identity and must be differentiated from adult services. Therefore, pediatric-related information will receive increased usage if it is part of a pediatric DHSL rather than part of a general DHSL. Others can use this process and the lessons learned to develop and enhance their own pediatric-related information on the Internet. Internet, pediatrics, digital health sciences libraries, digital library, medical library.