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Biomedical subjects

G Eysenbach

Publications and source records attributed to G Eysenbach.

At least 37 records · Page 2Linked to original sources
PubMed1999

Patients looking for information on the Internet and seeking teleadvice: motivation, expectations, and misconceptions as expressed in e-mails sent to physicians.

OBJECTIVES: To analyze the motivation, expectations, and misconceptions of patients seeking teleadvice or medical information on the Internet. To explore the possible economics and problems of direct physician-to-patient teleadvice via electronic mails (e-mail). DESIGN: Exploratory survey of 209 unsolicited e-mails mostly sent to physicians by individuals seeking teleadvice. SETTING: University dermatology hospital with a major Web site on the World Wide Web. PATIENTS: Two hundred nine patients and information-seeking individuals, mainly with dermatologic problems. MAIN OUTCOME MEASURES: Previous contacts with live physicians, disease duration, level of frustration expressed in the e-mails, and type of information sought. RESULTS: Many dermatologic patients who request teleadvice have a chronic disease (81%) and seek a second opinion. Seventeen percent express frustration about previous encounters with live physicians. Forty percent of all e-mails could have been answered by a librarian, 28% of all e-mails were suitable to be answered by a physician via e-mail alone, and in 27% of the cases any kind of consultation would not have been possible without seeing the patient. In at least 5 instances patients attempt self-diagnosis. CONCLUSIONS: We found examples for the beneficial effects of the provision of medical information on the World Wide Web but also evidence suggesting that patients are trying to use information on the Internet as a supplement for physicians and that teleadvice might be overused by chronically ill and frustrated patients looking desperately for additional information. Telemedicine via e-mail could substitute a physician visit or telephone call in some cases, but many principal problems must be solved beforehand.

Dermatology↗
PubMed1999

Labeling and filtering of medical information on the Internet.

Internet information undergoes no quality controls and virtually anybody can publish anything. Because of this, it is difficult for searchers to take information retrieved from the Internet at face value. A related problem is the uncontrolled promotion of medical products on the Internet. A further problem of today's Internet is that authors use no uniform keywords and other descriptive labels, which deteriorates the quality of search results. A solution for all these problems could be widespread use of descriptive and evaluative metainformation associated with medical Internet information. Our concept is based on a recently established infrastructure for assigning metadata to Internet information, the so-called PICS Standard (Platform for Internet Content Selection). We prototyped a PICS-based rating vocabulary for medical information (med-PICS), containing descriptive and evaluative categories, to be used by the webauthor and third-party label services (such as medical associations), respectively. We propose an international effort to assign metadata to medical Internet information.

Humans↗
PubMed1998

Responses to unsolicited patient e-mail requests for medical advice on the World Wide Web.

CONTEXT: The Internet is increasingly used by consumers to seek health and medical information, but online medical advice has not been explored systematically. OBJECTIVE: To explore the attitude of physicians and other providers of medical information on the Internet toward unsolicited e-mail from patients and their reaction to a fictitious acute medical problem described in such an e-mail. DESIGN: E-mail in December 1997 and January 1998 to Web sites from a fictitious patient describing an acute dermatological problem. Follow-up questionnaire survey to the same sites. SETTING: World Wide Web. SUBJECTS: Fifty-eight physicians and Web masters. MAIN OUTCOME MEASURES: Response rate and types of responses. RESULTS: Twenty-nine (50%) responded to the fictitious patient request; 9 respondents (31%) refused to give advice without having seen the lesion, 27 (93%) recommended that the patient see a physician, and 17 (59%) explicitly mentioned the correct "diagnosis" in their reply. In response to the questionnaire, 8 (28%) of the 29 respondents said that they tended not to answer any patient e-mail, 7 (24%) said they usually reply with a standard e-mail message, and 7 (24%) said they answer each request individually. CONCLUSIONS: Responses of physicians and Web masters to e-mail requests for medical advice vary as do approaches to handling unsolicited e-mail. Standards for physician response to unsolicited patient e-mail are needed.

Computer Communication Networks↗
PubMed1998

An international database on medical education: the European Medical School Information System (EMSIS).

An electronic database containing the curricula and other information of more than 200 medical schools from 40 different countries has been compiled and made accessible via the World Wide Web (http:@yi.com/emsis), with the aims of providing an overview and to enable a comparison of the curricula of Medical Schools in Europe, of facilitating the cooperation between Medical Schools in Europe and allowing medical students to plan their studying period abroad. The database contains the addresses of medical schools, general information about each medical school (number of students, hospital beds available for teaching, etc.), exchange information (exchange networks the medical school is participating in) and extensive curriculum information, consisting of more than 10,000 course descriptions. All information has largely been entered by the medical schools themselves. Medical schools may update the database directly via the Internet at any time. Users may perform simple queries, for example by country or city, or may perform more complex searches such as 'show all medical schools teaching gynaecology in the fourth year'.

Curriculum↗
PubMed1998

Digital images in dermatology and the Dermatology Online Atlas on the World Wide Web.

The digital revolution opens new ways of storing, retrieving and distributing images. The informativeness of digital images of dermatological conditions as compared to conventional photographs and slides has proven to be statistically similar; in many cases, digital images may even substitute for dermatologic physical examination. Current developments in high-speed, high-capacity international networks and the growing popularity of the World Wide Web are converging in ways that have great potential for enhancing access to biomedical information, including medical images. However, lack of metainformation and indexing services specialised in retrieving images makes finding images--as opposed to textual information--on the Web difficult. To provide an image collection and entry point into dermatological resources on the World Wide Web, we have developed an image database (Dermatological OnlIne Atlas--DOIA). The database, which is freely available on the Internet at http://dermis.net, contains about 3,000 clinical images covering more than 600 dermatological diagnoses. It is designed for worldwide use; international submissions are encouraged. It serves as a teaching tool for medical students, doctors and patients, assists professional users by being an easy gateway to other databases such as MEDLINE, PDQ, and OMIM and serves as a platform for conducting research by means of administering Internet surveys to users. We conclude that an online image atlas has multiple educational, clinical, and research applications.

Anatomy, Artistic↗
PubMed1998

An international dermatological image atlas on the WWW: practical use for undergraduate and continuing medical education, patient education and epidemiological research.

We describe the development of an image database DOIA (Dermatological OnlIne Atlas) and present several spin-off projects using images of the atlas, e.g. student education using the atlas including results of an questionnaire evaluating computer-literacy, prerequisites and interests of students for using computers and the World-Wide-Web (WWW), a patient information system and an experiment to collect epidemiological data from patients with dermatological diseases via WWW. The database, available on the WWW at http:@www.derma.med.uni-erlangen.de, contains about 3,000 clinical images covering more than 540 dermatological diagnoses. It is designed for worldwide use; international submissions are encouraged. One aim of the project is to compile an international reference for dermatological images, containing images of high educational quality and also covering conditions on different skin types and rare diagnoses which are not commonly illustrated in ordinary textbooks. All images were originally mapped to the Erlanger Diagnosis Code, which is a proprietary modified ICD-9 key, later also to the UMLS (Unified Medical Language System). In addition, images are described with keys for the location, physical attributes of the location and clinical and histopathological features of the lesion. In order to facilitate the integration of the atlas into other web-based medical resources and to allow easy access to additional information, the Erlanger Diagnosis Code was mapped to the CUIs (unique concept identifiers) of the UMLS Metathesaurus. One purpose of the UMLS is to allow conversion of terms from one controlled medical vocabulary to another, thus, mapping of our diagnosis code to the UMLS CUIs allows simultaneous search for a given diagnosis in a number of other databases and also access to our image database from other databases. Mapping was successful for 619 out of 1383 dermatological diagnosis terms. For images with these diagnoses we are able to provide a hyperlink to other databases available on the Internet, such as MEDLINE, PDQ and OMIM, with automatic retrieval using the preferred vocabulary of the respective database. By grouping all diagnoses into sets with similar morphologies we further integrated a differential diagnosis mode. In order to educate patients via the Internet, a separate patient information system has been developed, using images of the electronic atlas. As an experiment to explore the feasibility of the Internet to gather epidemiological data from patients, users are asked to complete an electronic questionnaire covering signs for atopy. We conclude that an online image atlas has multiple educational, clinical and research applications.

Computer-Assisted Instruction↗
PubMedDate not supplied

Evaluation of the usefulness of Internet searches to identify unpublished clinical trials for systematic reviews.

PRIMARY OBJECTIVE: To avoid selection and publication bias, systematic reviewers should employ a broad range of search techniques and make efforts to locate unpublished studies. We tried to establish whether searches on the World Wide Web (WWW) are useful to identify additional unpublished and ongoing clinical trials. RESEARCH DESIGN: Search strategies seven Cochrane systematic reviews were retrospectively adapted for the WWW in an attempt to find additional randomized controlled trials. METHODS AND PROCEDURES: A search strategy with the general pattern 'study methodology NEAR intervention NEAR condition' for the Internet search engine AltaVista was evaluated by measuring search time, recall of Internet searches for published studies; precision (proportion of webpages containing hints to relevant published and unpublished randomized clinical trials); number of additional unpublished or ongoing studies found on the Internet. MAIN OUTCOMES AND RESULTS: We reviewed 429 webpages in 21 hours and found hints to 14 unpublished, ongoing or recently finished trials, at least 9 were considered relevant for 4 systematic reviews. The recall of Internet searches to find references to published studies ranged between 0% and 43.6%, the precision for hints to published or unpublished studies range between 0% and 20.2%. CONCLUSIONS: Information on unpublished and particularly ongoing trials can be found on the Internet. A potential problem is the appraisal of non-peer reviewed electronic publications with questionable quality. More powerful search tools are needed. An 'Open Trial Initiative' is proposed to define a syntax for publishing trials on the web and to ensure interoperability of trial registers, so that special search engines can harvest information on ongoing and complete clinical trials.

Data Collection↗
PubMedDate not supplied

Online prescribing of sildanefil (Viagra) on the world wide web.

BACKGROUND: A growing number of prescription medicines such as Viagra are offered and sold directly to consumers on the Internet. Little is known about the structure and "quality" of these "virtual pharmacies" in terms of how responsibly "online-prescriptions" are actually issued. OBJECTIVE: To determine to what extent Viagra is sold on the Internet despite clear contraindications. METHODS: The World Wide Web was searched for companies who offer to issue prescriptions for Viagra online or sell Viagra without prescription. We pretended to be a patient in which the ordered drug (Viagra) is clearly contraindicated, and tried to obtain an online prescription for this drug on the Internet. Our test case was as a 69-year-old woman giving a sexual history of having "no orgasm," with obesity (165 cm/78 kg), coronary artery disease, and hypertension, and taking captopril, pravachol, atenolol, and erythromycin. RESULTS: Twenty-two distinct companies were identified, consisting of three different types: 2 required a written prescription by a "real" physician, 9 dispensed the drug without any prescription at all, and 11 issued an "online prescription" after an alleged physician reviewed the online order form containing medical questions. We tested 10 of the latter type, among them 8 based in the USA. We ordered a total of 66 pills worth US$ 1,802.84. Three companies, among them both European companies, delivered within 6, 10, and 34 days respectively, despite Viagra being clearly contraindicated. In 80% no complete history was taken, in 70% inappropriate medical terminology was used, and in only 2 cases was the order form reviewed by a physician who identified himself. CONCLUSIONS: Although a surprisingly high number of Internet pharmacies declined delivery, the public should be alerted to the risks involved with prescription drug prescribing and dispensing via the Internet.

Drug Prescriptions↗
PubMedDate not supplied

Towards ethical guidelines for dealing with unsolicited patient emails and giving teleadvice in the absence of a pre-existing patient-physician relationship systematic review and expert survey.

BACKGROUND: Many health information providers on the Internet and doctors with email accounts are confronted with the phenomenon of receiving unsolicited emails from patients asking for medical advice. Also, a growing number of websites offer "ask-the-doctor" services, where patients can ask questions to health professionals via email or other means of telecommunication. It is unclear whether these types of interactions constitute medical practice, and whether physicians have the ethical obligation to respond to unsolicited patient emails. OBJECTIVE: To improve the quality of online communication between patients and health professionals (physicians, experts) in the absence of a pre-existing patient-physician relationship or face-to-face communication, by preparing a set of guiding ethical principles applicable to this kind of interaction. METHODS: Systematic review of the literature, professional, and ethical codes; and consultation with experts. RESULTS: Two different types of patient-physician encounters have to be distinguished. "Traditional" clinical encounters or telemedicine applications are called "Type B" interactions here (Bona fide relationship). In comparison, online interactions lack many of the characteristics of bona fide interactions; most notably there is no pre-existing relationship and the information available to the physician is limited if, for example, a physician responds to the email of a patient who he has never seen before. I call these "Type A" consultations (Absence of pre-existing patient-physician relationship). While guidelines for Type B interactions on the Internet exist (Kane, 1998), this is not the case for Type A interactions. The following principles are suggested: Physicians responding to patients' requests on the Internet should act within the limitations of telecommunication services and keep the global nature of the Internet in mind; not every aspect of medicine requires face-to-face communication; requests for help, including unsolicited patient questions, should not be ignored, but dealt with in some appropriate manner; informed consent requires fair and honest labeling; health professionals and information providers must maintain confidentiality; health professionals should define internal procedures and perform quality control measures. CONCLUSIONS: Different media are appropriate at each point on the continuum between dispensing general health information and handling patient problems that would require the practice of medicine to solve. For example, email is a sufficiently capable medium for giving out general health information, while diagnosis and treatment usually requires at least advanced telemedical technology. Patients have to be educated that it is unethical to diagnose and treat over the Internet in the absence of a pre-existing patient-physician relationship, and if the interaction is limited to a single email. More research is needed to establish more evidence regarding situations in which teleadvice is beneficial and efficient.

Humans↗
PubMedDate not supplied

Report of a case of cyberplagiarism--and reflections on detecting and preventing academic misconduct using the Internet.

BACKGROUND: The Internet is an invaluable tool for researchers and certainly also a source of inspiration. However, never before has it been so easy to plagiarise the work of others by clipping together (copy & paste) an apparently original paper or review paper from paragraphs on several websites. Moreover, the threshold of stealing ideas, whether lifting paragraphs or perhaps even whole articles from the Internet, seems to be much lower than copying sections from books or articles. In this article, we shall use the term cyberplagarism to describe the case where someone, intentionally or inadvertently, is taking information, phrases, or thoughts from the World Wide Web (WWW) and using it in a scholarly article without attributing the origin. OBJECTIVES: To illustrate a case of cyberplagiarism and to discuss potential Methods using the Internet to detect scientific misconduct. This report was also written to stimulate debate and thought among journal editors about the use of state of the art technology to fight cyberplagiarism. METHODS: A case of a recent incident of cyberplagiarism, which occurred in the Journal of the Royal College of Surgeons of Edinburgh (JRCSEd), is reported. A systematic search of the Internet for informatics tools that help to identify plagiarism and duplicate publication was conducted. RESULTS: This is the first in-depth report of an incident where significant portions of a web article were lifted into a scholarly article without attribution. In detecting and demonstrating this incident, a tool at www.plagiarism.org, has proven to be particularly useful. The plagiarism report generated by this tool stated that more than one third (36%) of the JRCSEd article consisted of phrases that were directly copied from multiple websites, without giving attribution to this fact. CONCLUSIONS: Cyberplagiarism may be a widespread and increasing problem. Plagiarism could be easily detected by journal editors and peer-reviewers if informatics tools would be applied. There is a striking gap between what is technically possible and what is in widespread use. As a consequence of the case described in this report, JMIR has taken the lead in applying information technology to prevent and fight plagiarism by routinely checking new submissions for evidence of cyberplagiarism.

Copyright↗
PubMedDate not supplied

Evidence-based patient choice and consumer health informatics in the Internet age.

In this paper we explore current access to and barriers to health information for consumers. We discuss how computers and other developments in information technology are ushering in the era of consumer health informatics, and the potential that lies ahead. It is clear that we witness a period in which the public will have unprecedented ability to access information and to participate actively in evidence-based health care. We propose that consumer health informatics be regarded as a whole new academic discipline, one that should be devoted to the exploration of the new possibilities that informatics is creating for consumers in relation to health and health care issues.

Access to Information↗