Stereochemical influences on intervalence charge transfer in homodinuclear complexes of ruthenium.
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Journal Article↗
Biomedical subjects
D M D'Alessandro
Publications and source records attributed to D M D'Alessandro.
Empowering children and families with information technology.
Patient empowerment is the enhanced ability of patients to actively understand and influence their health status. Information is the key to patient empowerment. Without information, children and families cannot engage in meaningful discussions or make thoughtful decisions regarding medical care. Information sharing is a model for patient interaction with the health care system that may significantly improve the care of children and families. This article focuses on information technologies that utilize user-centered design principles and interactive capabilities to facilitate information sharing and to empower children and families. Examples include electronic pediatric personal medical records, customized health information systems, and interactive physician offices with electronic mail (e-mail) and telemedicine capabilities. Ideally, these systems would all be integrated. Successful implementation of new technologies will require thoughtful attention and balanced solutions to tensions between information sharing vs security, and curatorship vs censorship. Issues related to access and the digital divide must also be addressed. Acceptance and usability of new technologies is predicated on close collaboration among physicians, researchers in informatics, librarians, educators, and other professionals with expertise in the human-computer interface. Child and family empowerment will be both the driving force and ultimate outcome of information-sharing technologies.
Child↗
The readability of pediatric patient education materials on the World Wide Web.
BACKGROUND: Literacy is a national and international problem. Studies have shown the readability of adult and pediatric patient education materials to be too high for average adults. Materials should be written at the 8th-grade level or lower. OBJECTIVE: To determine the general readability of pediatric patient education materials designed for adults on the World Wide Web (WWW). MATERIALS AND METHODS: GeneralPediatrics.com (http://www.generalpediatrics.com) is a digital library serving the medical information needs of pediatric health care providers, patients, and families. Documents from 100 different authoritative Web sites designed for laypersons were evaluated using a built-in computer software readability formula (Flesch Reading Ease and Flesch-Kincaid reading levels) and hand calculation methods (Fry Formula and SMOG methods). Analysis of variance and paired t tests determined significance. RESULTS: Eighty-nine documents constituted the final sample; they covered a wide spectrum of pediatric topics. The overall Flesch Reading Ease score was 57.0. The overall mean Fry Formula was 12.0 (12th grade, 0 months of schooling) and SMOG was 12.2. The overall Flesch-Kincaid grade level was significantly lower (P<.0001), at a mean of 7.1, when compared with the other 2 methods. All author and institution groups had an average reading level above 10.6 by the Fry Formula and SMOG methods. CONCLUSIONS: Pediatric patient education materials on the WWW are not written at an appropriate reading level for the average adult. We propose that a practical reading level and how it was determined be included on all patient education materials on the WWW for general guidance in material selection. We discuss suggestions for improved readability of patient education materials.
Adult↗
A proposed solution for addressing the challenge of patient cries for help through an analysis of unsolicited electronic mail.
BACKGROUND: Unsolicited electronic mail (e-mail) is e-mail sent to a physician from a person unknown to the physician, who is seeking professional help. The purpose of this project was to analyze unsolicited e-mails sent to a digital textbook author to: 1) characterize the e-mails, 2) determine what resources would be necessary to answer the e-mails, and 3) propose a standard approach to reply to e-mails in a helpful yet medicolegally-responsive manner. MATERIALS AND METHODS: All e-mails (315) sent to a digital textbook author from October 1995 through October 1998 were abstracted. Variables included: date and location, sender type, patient age, subject, medical content, and resources necessary to answer the question. Data frequencies were obtained. RESULTS: The most common location was the.com domain (47.6%). The most common senders were laypersons (66%). Overall, 44.4% of the e-mails concerned children. Detailed, patient-specific information was sent in 63.2% of the e-mails. The most common subjects were overviews of a disease or problem (32.4%), differential diagnosis (16.8%), and therapy/treatment questions (15.9%). The medical content covered a broad range of specialties. Specialists were overwhelmingly the resource necessary to answer the e-mails (74.9%). CONCLUSIONS: Pediatricians with educational information on the Internet can expect an increase in the number of unsolicited e-mails as Internet usage expands. Laypersons regard even short passages to mean the author is an expert in that particular area. Pediatricians need to consider the ethical and medicolegal implications of responding to unsolicited e-mails. A nonpersonalized, standard e-mail reply is proposed that directs the sender to quality information resources that may be of further assistance. unsolicited electronic mail, e-mail, medical informatics, legal issues, ethical issues, digital libraries.
Adolescent↗
Information needs and information-seeking behaviors of on-call radiology residents.
RATIONALE AND OBJECTIVES: The authors performed a baseline analysis of the information needs and information-seeking behaviors of on-call radiology residents to learn how to better serve their on-call information needs in the future. MATERIALS AND METHODS: Print, electronic, and human information resources were made conveniently available to on-call radiology residents. A prospective, descriptive study was performed by using a modification of the critical incident technique to gather data from the residents every morning after being on call. Residents were asked to recall questions that arose, whether they sought answers to the questions, where they searched for answers, whether their search was successful, and whether they believed that patient care was affected. RESULTS: The residents had 182 questions that encompassed all organ systems, imaging modalities, and aspects of radiologic practice. Residents sought answers to 138 of the 182 questions (76%) by using a wide variety of resources, with staff members and textbooks being the most common. They found answers to 114 of 138 questions (83%); 100 of the 114 (88%) answered questions affected patient care. CONCLUSION: The ideal way to meet the information needs of on-call radiology residents is to devise an authoritative information resource that is compatible with their information-seeking behaviors.
Diagnostic Imaging↗
The virtual hospital: the digital library moves from dream to reality.
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CD-ROM↗
Do morning report format changes affect educational content?
OBJECTIVE: The goal of this prospective observational study was to determine if format changes in a paediatric morning report conference affected the educational content presented. DESIGN: Case presentations during paediatric morning report at the University of Iowa during the academic years 1995-96 (Format 1 - informal presentations) and 1996-97 (Format 2 - formal presentations) were analysed for demographics, clinical venues where patients were encountered, case diagnoses and ensuing discussion. A 10-item questionnaire of participants' attitudes was conducted during May 1997. SETTING: Department of Pediatrics, University of Iowa. SUBJECTS: Paediatric residency trainees. RESULTS: The number of cases was significantly decreased from 4 to 3.2 per morning report session. A wide variety of patient ages and all clinical venues were represented in both formats. Case diagnoses covered 30 of 31 Pediatrics Review and Education Program (PREP, American Academy of Pediatrics, Elk Grove Village, IL, USA) Content Specification Headings during Format 1 vs. 29 of 31 during Format 2. The most common headings were the same. Patient evaluations were discussed less and patient clinical presentations and pathophysiology were discussed more during Format 2. Participants rated Format 2 higher; 54% of participants wanted to continue this format and 16% wanted a combination of both formats. CONCLUSIONS: This research suggests that while format changes in paediatric morning report resulted in a 20% decrease in the number of cases presented, only relatively small changes in the overall educational content occurred. Changes in educational programmes should be accompanied by educational evaluation.
Curriculum↗
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.
Data Collection↗
Information needs of naval primary care providers and patients at sea.
OBJECTIVE: To optimally practice medicine, and to live healthy lives, providers and patients need convenient access to authoritative information. The goal of this study was to determine the information needs of naval primary care providers and patients at sea to aid development of a digital health sciences library for naval primary care providers and patients. METHOD: A literature-based needs assessment was conducted from articles identified using MEDLINE searching and U.S. Navy health care information sources. Recurring medical problems/diseases/topics were identified and categorized. RESULTS: Eighty-one articles and books were reviewed and abstracted, representing a broad base of naval medicine. Twenty-one medical and surgical theme areas and 125 medical problems/diseases/topics were recurrently identified. CONCLUSIONS: The common naval medical problems identified are nearly identical to the common medical problems in the general population, have changed little from the 18th century, and were consistent with first-hand information from naval primary care providers.
Databases, Factual↗
Usage analysis of a primary care medical resource on the Internet.
Physicians and patients need convenient access to quality medical information. This study's goal was to place a medical resource on the World-Wide Web (WWW), allow access to it through a simple to use interface, and analyze the usage of such a resource. The Family Practice Handbook (TFPH) was digitized and placed onto the WWW. Usage data was obtained from June 1995-June 1996. 118,804 individuals accessed TFPH viewing 409,711 pages of information. A broad spectrum of topics was accessed. TFPH proved to be an extremely popular resource, servicing the broad information needs of an international audience. These preliminary findings suggest the future promise of Internet medical resources.
Arthritis, Rheumatoid↗
A performance comparison of communication links between rural hospitals and a digital health sciences library.
BACKGROUND: Rural physicians need access to digital health sciences libraries (DHSLs) that is easy and reasonably rapid. The goal of this project was to study rural hospitals' access to a DHSL on the Internet, by comparing differing access speeds with differing costs and their acceptability for retrieving text, image, and video information in a DHSL. METHODS: DHSL system response time was measured at three different times during the day over three different types of network connections (T1, Frame Relay, Modem). Text, image, and video information was retrieved. Costs were determined for installation and operation of the different types of network connections. RESULTS: System response times were consistent at the three different testing times for each media type retrieved by each of the three network connection types. System response times for text retrieval met literature standards for all connections. Image retrieval met literature standards for T1 and Frame relay connections. No connection met literature standards for video retrieval. CONCLUSIONS: High speed access to DHSLs is preferable; Frame relay connections provide substantively similar service as T1 connections at less cost. However, access via modem to a DHSL can provide access to the majority of information--text--in a DHSL with an acceptable system response time.
Costs and Cost Analysis↗
Barriers to rural physician use of a digital health sciences library.
BACKGROUND: Rural physicians need access to quality medical information, but accessing information is difficult in rural settings. Digital health sciences libraries (DHSLs) offer the potential to make information more accessible to rural physicians. A telemedicine network was deployed to six rural hospitals in Iowa. Computers were installed allowing access to a DHSL and training sessions were held. The purpose of this study was to examine the barriers to use of a DHSL by rural physicians. METHODS: Approximately one year after deployment of the telemedicine network, physicians were surveyed using a modified critical incident technique. RESULTS: Seventy percent of the eligible physicians responded and 33% had used the DHSL. Primary barriers included insufficient training, being too time consuming to use, and distance of computers from physicians' practice sites. Non-DHSL users cited the difficulty of using the DHSL as their greatest barrier, while DHSL users cited the quality of the information resources. CONCLUSIONS: This study identifies a number of barriers that exist to rural physicians use of a DHSL. Potential solutions to these barriers are discussed. DHSLs will finally reach their potential when they can be delivered by easy to use handheld computers seamlessly integrated into the rural physician's workflow.
Adult↗
Performing continuous quality improvement for a digital health sciences library through an electronic mail analysis.
BACKGROUND: The goal of this prospective, cross-sectional study was to determine the user demographics of a digital health sciences library (DHSL), motives for use, the nature of users information requests, and success rate in finding answers. METHODS: The content of 500 consecutive electronic mail messages (e-mails) submitted to a DHSL were analyzed using a predetermined coding scheme. Data were entered into a database and frequency analysis was performed. RESULTS: The number of information requests from the 500 e-mail messages was 751. The largest sender category was patients and laypersons followed by students, then physicians. Motivations for use were primarily medical advice (42.8%) and patient care (13.8%). E-mail subject areas were mainly medical (61.8%) and technical (20.6%). Answers to information requests were found 54.3% of the time and senders felt the DHSL was valuable (97.8%). CONCLUSIONS: A DHSL is a valuable medical resource. DHSLs must serve the broad information needs of patients and laypersons in addition to health care providers. Developers and managers of DHSLs can use this information to guide future development of DHSL information content and services, as has been done at The University of Iowa.
Adult↗
Evaluating overall usage of a digital health sciences library.
BACKGROUND: Digital health sciences library (DHSL) evaluation involves studying the usage of the DHSL by individuals as well as populations. The purpose of this study was to evaluate trends in overall usage of a DHSL as part of a process of continuous quality improvement in order to learn how to enhance a DHSL in order to meet its users' needs better. METHODS: Web server log file analysis was performed on a prototype DHSL, the Virtual Hospital, using two log file analysis programs on data from the month of February over four consecutive years, 1995 to 1998. RESULTS: Overall DHSL usage increased between 1995 and 1997 and leveled off in 1998. Fifteen percent of usage came from countries outside the United States. A broad spectrum of medical information for health care providers and patients was accessed and centered around specialty medical information. CONCLUSIONS: To be of optimal assistance to users, DHSLs should (1) contain a broad base of information on common and uncommon medical problems, (2) accommodate the needs of the significant percentage of users that are international through content translation and mirroring, and (3) ensure they are indexed and catalogued in the major Web search engines and Web general and medical indices so they can be easily found by users.
Evaluation Studies as Topic↗
The Virtual Naval Hospital: a digital library for naval primary care providers and patients.
OBJECTIVE: To deliver optimal patient care and promote wellness, naval providers and patients require convenient access to medical information from isolated duty stations. The Internet can lower barriers to accessing information. The goal of this study was to determine the technical feasibility of using the Internet to deliver medical information to isolated naval points of care. METHODS: A digital library for naval primary care providers and patients with an integrated, problem-based interface was developed. The Virtual Naval Hospital (http:/(/)www.vnh.org) was evaluated from sea, undersea, and shore. RESULTS: The digital library was a popular resource. Access to it is currently limited because few ships have Internet access. CONCLUSIONS: The technical feasibility of delivering a digital library of medical information to the deckplates was proven. The digital library will realize its potential when satellite-based access to the Internet becomes available. In the interim, the digital library will also be distributed on CD-ROM.
CD-ROM↗
Peer reviewing and curating the health care information infrastructure: experiences and recommendations.
As part of a digital health sciences library's continuous quality improvement process, a digital textbook of common medical problems was created which contained links to authoritative medical information on the Internet for patients and health care providers. The accomplishments of this project were the: 1) Identification of 50 common medical problems, 2) Development of a methodology for identifying authoritative medical information related to these problems, 3) Creation of a digital textbook containing links to this information with a problem-based interface, 4) Development of a methodology to allow local peer review of this information, and 5) Evaluation of the use of the information and the local peer review methodology.
Evaluation Studies as Topic↗
Documenting the educational content of morning report.
OBJECTIVES: To document the educational content of a pediatric morning report and to determine if it represents a curriculum. SETTING: A midwestern, tertiary care, pediatric training program. DESIGN: A prospective, observational study was conducted of case presentations discussed during pediatric morning report from July 1995 through July 1996. Presented cases were analyzed for demographics, clinical venues where patients were encountered, case diagnoses, and ensuing discussion. RESULTS: Morning report by study criteria was considered a curriculum. A wide variety of patient ages (aged from birth to 41 years) and all clinical venues were represented. A broad spectrum of diagnoses covered 30 of 31 Pediatrics Review and Education Program (American Academy of Pediatrics, Elk Grove Village, Ill) Content Specification headings and most (72%) of the Educational Objectives listed (N = 977 [72%]). The most common topic areas were infectious diseases (n = 137 [18.2%]), disorders of the blood/neoplasms (n = 85 [11.2%]), neurological disorders (n = 57 [7.5%]), genetics or dysmorphology (n = 56 [7.4%]), and gastrointestinal tract disorders (n = 44 [5.8%]). Top discussion categories were patient clinical presentation (n = 399 [19.6%]), evaluation (n = 375 [18.4%]), and management (n = 377 [18.5%]). CONCLUSIONS: Morning report represents a curriculum in a pediatric residency training program. It can be used effectively to address nontraditional or rarely discussed topics that are important to the overall professional development of pediatric residents.
Adolescent↗
Longitudinal follow-up comparison of educational interventions: multimedia textbook, traditional lecture, and printed textbook.
RATIONALE AND OBJECTIVES: The goal of this prospective, interinstitutional study was to compare the long-term instructional effectiveness of a pediatric multimedia textbook (MMTB) to that of a standard lecture and a printed textbook. MATERIALS AND METHODS: A randomized cohort of 89 3rd-year medical students from two institutions were initially evaluated from June 1992 to June 1993 and reevaluated in May 1994. Students were randomly assigned to one of four instructional groups: computer-aided instruction by means of MMTBs (n = 21), traditional lecture (n = 23), printed textbook (n = 19), and a control group (n = 26). After instruction, all groups were tested by means of a multiple choice test at the end of their pediatric clerkship; they were given this same test 11-22 months later. RESULTS: The long-term instructional effectiveness of the MMTB, printed textbook, and lecture were the same as that in the control group, as determined by analysis of variance of mean test scores. CONCLUSION: The educational advantage of MMTBs observed immediately after instruction was not detected 1 year later. Because attrition reduced statistical power, further research is necessary to determine how educational fading affects these instructional formats.
Analysis of Variance↗