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Using electronic mail for a small-group curriculum in ethical and social issues.

PURPOSE: To initiate an electronic mail (e-mail) program as a supplement to a medical humanities curriculum focusing on ethical and social issues. METHOD: In 1991-92 an e-mail track (called NET) was established for second-year students participating in Medicine in Contemporary Society, a four-year curriculum in medical humanities at the State University of New York at Stony Brook School of Medicine. In 1991-92 ten students volunteered to form a NET group; in 1992-93 22 students, forming two groups, were randomly selected from a volunteer pool of 76 students (from a class of 100). In both study years, the NET students analyzed and discussed electronically a series of cases posted sequentially through the academic year. Faculty tutors reviewed the students' responses, interacting with the groups and with individual students by e-mail. NET was evaluated in two ways: at the end of the course, the students completed e-mail questionnaires that included quantitative and qualitative assessments; and throughout the course, the tutors assessed the students' participation, quality of case analysis and discussion, and quality of writing. RESULTS: The students' assessments indicated that they considered NET to be more educational than the lectures, "live" group discussions, problem-based learning exercises, and formal papers in the medical humanities curriculum; that they made gains in computer literacy; and that NET enhanced their abilities to think about ethical and social issues. The tutors judged that the students had improved their written self-expression as the course progressed. CONCLUSION: NET adequately accomplished the goals set for it as an adjunct to the small-group sessions and other components of the medical humanities curriculum.

Attitude↗

The Emerging Infections Network electronic mail conference and web page.

In February 1997, the Emerging Infections Network (EIN) established an electronic mail conference to facilitate discussions about emerging infectious diseases and related topics among its members and public health officials. Later that year, the EIN opened its section of the Infectious Diseases Society of America's home page. The EIN Web page was developed to give its members an alternative route for responding to EIN surveys and to facilitate rapid dispersal of EIN reports. The unrestricted portion of the site allows visitors access to information about the EIN and to published EIN reports on specific topics. For the most part, these are brief summaries or abstracts. In the restricted, password-protected portion of the EIN site, members can access the detailed, original reports from EIN queries and the comprehensive listings of member observations. Search functions in both portions of the EIN site enhance the retrieval of reports and observations on specific topics.

Communicable Diseases, Emerging↗

Integrating CD-ROM Medline with electronic mail: first step in implementing new strategy for online reference library.

Simultaneous ACCESS to and DISSEMINATION of electronically available PROFESSIONAL KNOWLEDGE, in a productive, Cost-of-Ownership effective, and affordable manner are now achievable. Emerging MANAGEMENT-OF-INFORMATION and SYSTEMS-INTEGRATION disciplines are essential contributing factors to devising and implementing NEW STRATEGIES for ONLINE REFERENCE LIBRARIES. Bringing integrated information closer to the ultimate user and RESHAPING the electronic databases and full-text management systems MARKETPLACE are the most significant outcomes. Key technology attributes are advancements in CD-ROM, Networking, and office automation. We have proven this concept by developing an INTERFACE between MEDLINE from COMPACT CAMBRIDGE and ALL-IN-1 from DIGITAL EQUIPMENT CORPORATION. Saved search results are automatically routed to the individual's ALL-IN-1 account where further DOCUMENT MANAGEMENT and electronic mail functions may be performed. A 486Ware system from Logicraft and a five-members VAX-Cluster (respectively), are linked in a DECNet environment that is the foundation of Children's Integrated Hospital Information System. In phase one of the project up to 8 SIMULTANEOUS USERS may access the 8 RECENT YEARS, from any one of 1500 ACCESS POINTS (local and remote), and utilize any one of 150 NETWORKED PRINTERS. Opportunities are now within reach to expand the electronic library services while utilizing progressive methods and taking advantage of the best available technologies.

Boston↗

Ergonomics of electronic mail address systems: related literature review and survey of users.

The paper reviews the cognitive ergonomics literature related to electronic mail (e-mail) address design. Based on this information, a survey of 160 users of current e-mail address system was conducted. The aim was to obtain information on likes, dislikes and difficulties associated with e-mail address and to obtain users' suggestions and input for improving the current e-mail address system. The survey results indicated that users want an improved e-mail address system with regard to shorter length, useful information and appropriate presentation of information.

Computer Communication Networks↗

Nurse practitioner practice and deployment: electronic mail Delphi study.

BACKGROUND: The nature of modern government and needs of policy-makers demand accurate information that is delivered quickly. This study was part of a larger project for the Department of Health relating to nurse practitioner (NP) education and practice in UK. AIMS: The aim of the study was to identify the principal factors that help or hinder the development of NP roles in the National Health Service. METHODS: In order to facilitate a rapid response, a Delphi study was undertaken using electronic mail (e-mail) and was completed within 4 weeks. Key stakeholders in NP practice, education and research and (non-governmental) policy-making were invited to participate. Key themes relating to the deployment and practice of NPs were generated. These were refined and collated by the research team and then rated by the respondents. RESULTS: This approach generated valuable expert consensus data around NP deployment and practice. Nurse practitioners' practice is recognized as an integral part of health care that needs to be recognized by regulatory bodies to promote understanding of their potential at local levels. Nurse practitioners need freedom to innovate, adequate support and appropriate education to allow true autonomy. Limited prescribing and local restrictions on requesting investigations hinder practice. LIMITATIONS: Although this was a small-scale study, the expert panel was wide-ranging and achieved substantial consensus. CONCLUSION: The organisational and cultural changes that are required to foster the development of practice and deployment of NPs have yet to be instigated, according to the comments of the key stakeholders in this study. There appears to be a clear message that the government needs to take a more interventionist role in supporting nursing developments, rather than leaving this to local arrangements.

Delphi Technique↗

The effects of electronic mail on communication in two health sciences institutions.

A study was done during 1991-1992 to determine the perceived impact of electronic mail (E-mail) relative to other forms of communication in health sciences institutions. E-mail subscribers at two major health sciences institutions were sent 2919 surveys, and 823 (28%) completed survey instruments were returned. A significant positive impact of E-mail was found relative to other forms of communication (e.g., paper, phone) with regard to E-mail messaging, response rates, influence, value, formality, perceptions, errors in communication, cost-effectiveness, communication style, and other factors. Areas where no differences were found between communication mechanisms were also revealing. Technical problems, maintenance, and confidentiality of E-mail messaging were not found to be significant problems. Trends, value, and impact of E-mail use in health sciences institutions are also discussed.

Academic Medical Centers↗

An SDI program for distributing funding opportunities using electronic mail.

As the competition for funding increases, the need to make researchers aware of all available funding is becoming more acute. The solution presented here is a Selective Dissemination of Information (SDI) service which electronically mails funding information that matches a researcher's keywords. The keywords are part of extensive faculty profiles that make up a Faculty Expertise database. The funding information comes from the Sponsored Programs Information Network (SPIN) database. The software enables researchers to learn about appropriate funding opportunities without spending time actively searching for them.

Databases, Factual↗

Postal surveys versus electronic mail surveys. The tortoise and the hare revisited.

The advent of computer-based technology has led to a consideration of change in research methods that exploit the advantages of computer-mediated communications. In survey research, electronic mail (e-mail) has anecdotally shown particular promise as a data collection tool. This article compares traditional postal and nontraditional e-mail surveys within the context of a larger listserv evaluation project in terms of overall return rate, distribution of survey returns over time, response to initial and follow-up mailings, representativeness of respondent groups, thoroughness of survey completion, and the likelihood of respondents to include additional written comments. In summary, whereas postal surveys were shown to be superior to e-mail surveys with regard to response rate, all things being equal, the decision of which to use may be situation-specific, dependent on issues such as survey cost, desire for convenience and timeliness in data collection, and need for higher response rates, among others.

Attitude of Health Personnel↗

Physician-to-physician consultation via electronic mail: the Walter Reed Army Medical Center Ask a Doc system.

INTRODUCTION: Physician-to-physician consultation and discussion have traditionally been conducted by telephone, paper, and "curbside" (face to face meetings). The implementation and use of physician-to-physician consultation via electronic mail in a military health care system has not been reported previously. METHODS: The group mail function of the Composite Health Care System, the main outpatient medical automation system for the Department of Defense, was modified to create mailgroups for every specialty of the Walter Reed Army Medical Center to facilitate ease of physician-to-physician consultation. This modification was called the "Ask a Doc" system. The system was deployed to a 21-state health care network among triservice participants. RESULTS: There were 3,121 consultations logged from April 22, 1998, to December 31, 2000. Growth in use expanded initially and was sustained during a 3-year period. Average response time to consultations was less than 1 day (11.93 hours). Additional training and maintenance requirements were minimal. In general, the use of electronic consultation mirrored that of clinical practice. Most specialty consultations involved the disciplines of internal medicine. CONCLUSIONS: Use of the Ask a Doc system was representative of total clinical workload and increased access to specialty medical care over a wide geographic area. The distribution of use indicated that user statistics were legitimate, and quality improvement programs could easily troubleshoot the system. Ask a Doc was inserted into a regional health care network with minimal cost to support and implement and was sustained with very little effort for 3 years. Barriers to even wider use currently include lack of secure communications and the difficulty in assigning workload credit for electronic consultations.

Computer Communication Networks↗

Enhancing therapeutic impact and therapeutic alliance through electronic mail homework assignments.

Homework assignments can enhance therapeutic impact and increase therapy effectiveness by encouraging patients to focus on therapy-related issues between sessions. Computer technology provides a new avenue for reporting, monitoring, and feedback of patient homework assignments through electronic mail (e-mail). In two case examples, e-mail was used as an extension of therapy to enhance patient involvement in treatment. In both cases, patient reports suggest that therapeutic alliance and therapeutic impact improved with the use of e-mail homework reporting. The costs and benefits of the use of e-mail as an adjunct to therapy are discussed.

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↗

Electronic mail and privacy: setting your company's policy.

In setting a privacy policy, a company must consider not only its interest and the interests of its employees, but also the interests of third parties, including suppliers, customers, law enforcement agencies, and others who may have a legal right to or interest in accessing company records, including electronic mail.

Civil Rights↗

Telepathology applications of the Internet multimedia electronic mail.

Telepathology is based on the sharing of medical images coming from the microscope, and comprises different applications: intra-operative telediagnosis, second opinion teleconsultation, reference case archives, remote data and image processing, quality assessment. Since the Internet is available worldwide, it can be of interest to define which of these tasks can be performed by means of some telepathology method based on it. This paper focuses particularly on the use of Internet multimedia electronic mail for exchanging multimedia cases. To test the validity of the proposed approach for transmission of multimedia cases, the first step is to evaluate its diagnostic accuracy. Trials involving the transmission of 299 cases have been carried out between two departments of Pathology in Italy (at the University of Udine and at the City Hospital of Trento, respectively) in order to evaluate the diagnostic accuracy as well as the time needed for acquisition and transmission. First results show that good diagnostic agreement can be reached, but the time needed for transmission, generally low, is not sufficiently affordable to be adopted in those cases where time is important. In particular, telepathology through multimedia e-mail can be adopted for second opinion consultation, remote image processing, quality assessment and continuing education possibly by means of software that integrates acquisition and delivery of cases with HIS functionalities.

Evaluation Studies as Topic↗

Results of an electronic mail survey on hormones and telangiectasias.

BACKGROUND: The relationship between the development of telangiectasias and hormonal intake has not been well studied and is empirically managed by phlebologists. OBJECTIVE: To understand the behavior of the international phlebologic community regarding the treatment of leg telangiectasia in patients taking oral contraceptives or receiving postmenopausal hormone replacement therapy. METHODS: Simple questions concerning the causal effects of hormones, their influence on treatment, and general behavior were asked by an electronic mail questionnaire sent to 131 phlebologists in my personal database. RESULTS: The 61 answers received show the existence of two opposite "parties" concerning the influence of hormones on telangiectasia: cause and treatment. CONCLUSION: Opposite opinions without any scientific basis underline the ignorance surrounding a subject that concerns 50% of our patients.

Contraceptives, Oral↗

Electronic mail was not better than postal mail for surveying residents and faculty.

OBJECTIVE: To compare response rate, time to response, and data quality of electronic and postal surveys in the setting of postgraduate medical education. STUDY DESIGN AND SETTING: A randomized controlled trial in a university-based internal medicine residency program. We randomized 119 residents and 83 faculty to an electronic versus a postal survey with up to two reminders and measured response rate, time to response, and data quality. RESULTS: For residents, the e-survey resulted in a lower response rate than the postal survey (63.3% versus 79.7%; difference -16.3%, 95% confidence interval (95% CI) -32.3% to -0.4%%; P=.049), but a shorter mean response time, by 3.8 days (95% CI 0.2-7.4; P=.042). For faculty, the e-survey did not result in a significantly lower response rate than the postal survey (85.4% vs. 81.0%; difference 4.4%, 95% CI -11.7 to 20.5%; P=.591), but resulted in a shorter average response time, by 8.4 days (95% CI 4.4 to 12.4; P < 0.001). There were no differences in the quality of data or responses to the survey between the two methods. CONCLUSION: E-surveys were not superior to postal surveys in terms of response rate, but resulted in shorter time to response and equivalent data quality.

Adult↗

"We got mail": electronic communication between physicians and patients.

E-mail has the potential to improve both the quality and efficiency of healthcare service delivery. Despite the substantial growth of this form of communication over the past decade, its promise to patients, providers, and their health plans remains largely untapped. In this article we (1) review the literature on e-mail use between patients and providers; (2) identify challenges and opportunities facing managed care organizations that wish to maximize the potential of this form of communication; (3) describe the components of 2 systems aimed at enhancing e-mail use in clinical settings; and (4) discuss the implications of increased e-mail use for managed care.

Communication↗

Maintaining interpersonal and organizational relations through electronic mail by men and women.

E-mail is used to maintain two primary human relationships, interaction between individuals and preserving relationships with organizations. 278 participants from a medium-size university in the southwest completed two measures developed to assess the quantity of e-mail used to maintain interpersonal and organizational relationships. Analysis indicated that men (M = 5.8, SD = 2.7) and women (M = 6.6, SD = 2.5) significantly differed in frequency of e-mail used to maintain interpersonal relationships, but not in reference to organizational maintenance.

Electronic Mail↗