Medical information and the Internet: do you know what you are getting?

Due to the Internet technology, hundreds of Web sites are accessible for medical information, and the retrieval of such information is quite rapid. Once you as a consumer obtain all of this information, how do you determine whether the information you are looking at is valid and current and even relevant to your needs? This article presents various criteria necessary to evaluate the information on a medical Web site; no standards currently are in place to mandate the validity of information published on the Internet.     

Access to Health Information and Support: A Public Highway or a Private Road?

Thomas R. Eng, VMD, MPH; Andrew Maxfield, PhD; Kevin Patrick, MD, MS; Mary Jo Deering, PhD; Scott C. Ratzan, MD, MPA, MA; David H. Gustafson, PhD

JAMA. 1998;280:1371-1375.

Information and communication technologies may help reduce health disparities through their potential for promoting health, preventing disease, and supporting clinical care for all. Unfortunately, those who have preventable health problems and lack health insurance coverage are the least likely to have access to such technologies. Barriers to access include cost, geographic location, illiteracy, disability, and factors related to the capacity of people to use these technologies appropriately and effectively. A goal of universal access to health information and support is proposed to augment existing initiatives to improve the health of individuals and the public. Both public- and private-sector stakeholders, particularly government agencies and private corporations, will need to collaboratively reduce the gap between the health information "haves" and "have-nots." This will include supporting health information technology access in homes and public places, developing applications for the growing diversity of users, funding research on access-related issues, ensuring the quality of health information and support, enhancing literacy in health and technology, training health information intermediaries, and integrating the concept of universal access to health information and support into health planning processes.

     

Medical education and patients' responsibilities: back to the future?

Medical student learning is dependent on an unwritten agreement between patients and the medical profession, in which students "practise" upon real patients in order that, when they are doctors, those same patients will benefit from the doctors' skills. Given the increasing propensity for patients to refuse to take part in such learning, there is a danger that doctors will qualify without being truly competent. As patients, we must all ask ourselves, when asked to take part in medical teaching: if this student/trainee doesn't learn now, on me and under supervision, how will the person be truly competent next time, when this is for real, and the patient might be me or my loved one? We argue that a new and more explicit agreement is needed, in which the default should be that all patients are willing to help in the education of medical students, while we ensure that all such students are already competent in simulation before first practising upon real patients.     

Alternatives to Project-specific Consent for Access to Personal Information for Health Research: What Is the Opinion of the Canadian Public?

Objectives

This study sought to determine public opinion on alternatives to project-specific consent for use of their personal information for health research.

Design

The authors conducted a fixed-response random-digit dialed telephone survey of 1,230 adults across Canada.

Measurements

We measured attitudes toward privacy and health research; trust in different institutions to keep information confidential; and consent choice for research use of one’s own health information involving medical record review, automated abstraction of information from the electronic medical record, and linking education or income with health data.

Results

Support was strong for both health research and privacy protection. Studying communicable diseases and quality of health care had greatest support (85% to 89%). Trust was highest for data institutes, university researchers, hospitals, and disease foundations (78% to 80%). Four percent of respondents thought information from their paper medical record should not be used at all for research, 32% thought permission should be obtained for each use, 29% supported broad consent, 24% supported notification and opt out, and 11% felt no need for notification or consent. Opinions were more polarized for automated abstraction of data from the electronic medical record. Respondents were more willing to link education with health data than income.

Conclusions

Most of the public supported alternatives to study-specific consent, but few supported use without any notification or consent. Consent choices for research use of one’s health information should be documented in the medical record. The challenge remains how best to elicit those choices and ensure that they are up-to-date.     

Research ethics and lessons from Hwanggate: what can we learn from the Korean cloning fraud?

In this review of the Korean cloning scandal involving Woo-Suk Hwang, the nature of the disaster is documented and reasons why it occurred are suggested. The general problems it raises for scientific research are highlighted and six possible ways of improving practice are offered in the light of this case: (1) better education of science students; (2) independent monitoring and validation; (3) guidelines for tissue donation for research; (4) fostering of debate about ethically contentious research in science journals; (5) development of an international code of ethical research practice; (6) fostering of public involvement in ethical review and debate through the web.     

Thanks for Your Accompanying in the Journey of Integrative Medicine——Strength and Con?dence from the Predecessors of Chinese Medical Association

<正>After graduation from Fujian Medical College(now named Fujian Medical University)in 1954,I had my residency training at the Department of Internal Medicine of University Hospital.In early 1956,I came to China Academy of Traditional Chinese Medicine(now named China Academy of Chinese Medical     

Pain in pediatric oncology: do the experiences of children and parents differ from those of nurses and physicians?

Diagnosis and treatment of pain are central components in the care of children with cancer. The aim of the present study was to compare the viewpoints of children and parents with those of professionals, on different aspects of pain in children with cancer. Information was collected through questionnaires and interviews. In particular, we focused on the extent and causes of pain, strategies to reduce procedural pain, pain evaluation, and attitudes to pain treatment. We found that both families and professionals shared the opinion that pain was a common symptom during different phases of cancer treatment but, surprisingly, professionals regarded it as more frequent than families. The groups agreed that treatment related pain is the most critical problem, followed by procedure and cancer related pain. Concerning strategies to decrease procedural pain, there was a high concordance in views between groups. Nurses and physicians more often claimed that failing pain treatment was associated with psychological factors such as high levels of anxiety in parents and children, loneliness, and lack of preparation. The self-report, according to both parents and professionals, is a feasible procedure even in young children from 4 years of age. Both groups asserted that parents were better in ascertaining the extent of their child's pain. In conclusion, although the families and professionals in this study have many comparable views concerning pain in children with cancer, divergences also exist. To acquire a more accurate picture of the situation we must focus on the views of the children first, and then those of parents and professionals. A tendency to overestimate the problems was observed in professionals. Hopefully this reflects a keen awareness of the current situation.     

Wound healing mechanisms and regulation of pulmonary fibrosis: how far are we from the hilltop?

Lungs are located in the chest and lie on both sides of mediastinum.The major function of lung is to balance the external and internal 'gas' environment and to maintain homeostatic equilibrium.Because lung is closely interacted with outside surroundings as well as general circulation,it is fair to say that lung is a delicate organ which may be attacked by so many noxious stimuli,such as bacterial or viral infections,chemical insults (smoke,dust,etc),radiation,autoimmune and allergic responses.Damage to lung tissue can result from these various acute or chronic stimuli,which in tum disrupt lung homeostasis and a dysregulated healing response will eventually occur, such as inflammation,anti-fibrinolytic coagulation cascade and accumulation of pro-angiogenic,and fibrogenic cytokines,growth factors and enzymes.Uncontrolled healing response could gradually evolve into a pathogenic fibrotic response when important checkpoints are missed and inflammation becomes unrelenting.     

A retrospective look at the predictions and recommendations from the 2009 AMIA policy meeting: did we see EHR-related clinician burnout coming?

Clinicians often attribute much of their burnout experience to use of the electronic health record, the adoption of which was greatly accelerated by the Health Information Technology for Economic and Clinical Health Act of 2009. That same year, AMIA’s Policy Meeting focused on possible unintended consequences associated with rapid implementation of electronic health records, generating 17 potential consequences and 15 recommendations to address them. At the 2020 annual meeting of the American College of Medical Informatics (ACMI), ACMI fellows participated in a modified Delphi process to assess the accuracy of the 2009 predictions and the response to the recommendations. Among the findings, the fellows concluded that the degree of clinician burnout and its contributing factors, such as increased documentation requirements, were significantly underestimated. Conversely, problems related to identify theft and fraud were overestimated. Only 3 of the 15 recommendations were adjudged more than half-addressed.     

What Are the Factors Determining Authorship and the Order of the Authors' Names?: A Study Among Authors of the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine)

Context.— Although criteria justifying authorship of scientific medical articles have been formulated, it is not well known how authorship is established in practice. Objectives.— To assess the criteria for authorship used by authors of original articles in Nederlands Tijdschrift voor Geneeskunde (NTVG, the Dutch Journal of Medicine), and to determine whether the criteria for authorship of the International Committee of Medical Journal Editors (ICMJE) are known and applied. Design.— Survey questionnaire. Setting.— Editorial office of the NTVG. Participants.— All 450 authors of 115 original articles published in 1995. Main Outcome Measures.— Author's contribution to study design, material, collection of data, statistics, and writing. Results.— Of 362 forms returned, 352 could be analyzed (78.2% response rate). The 5 questions most frequently answered affirmatively were ICMJE criteria: critical reading (86.1% of the authors), approval of the final version (84.7%), study design (74.7%), study conception (64.2%), and revision (63.4%). Authors rated their contribution 2 points higher than did their coauthors. Interestingly, 64% of the respondents met the ICMJE criteria, although 60% of the respondents did not know them. Conclusion.— Authorship was mostly in accordance with ICMJE criteria although many authors were not familiar with them.