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PubMedDate not supplied

[Meta-analysis of the diagnostic efficacy of FDG-PET in patients with suspected ovarian cancer recurrence].

AIM: The aim of this paper was to perform a meta-analysis of the literature to evaluate the accuracy of FDG-PET in recurrence detection in patients with ovarian cancer. METHODS: The search strategy consisted in identifying papers published between November 1972 and October 2003 indexed in MEDLINE and CANCERLITE. Inclusion criteria were publications that evaluated recurrence with FDG-PET in patients with ovarian carcinoma. Exclusion criteria were duplicated papers or those outdated by subsequent ones. The statistical analysis included 95 % confidence intervals (CI) of sensitivity (S), specificity (Sp) and natural logarithm of the odds ratio (Ln OR). RESULTS: Seventeen publications fulfilled the inclusion criteria and were analyzed. The S and Sp were 0.94 (95% CI, 0.93-0.96) and 0.65 (95% CI, 0.46-0.85), respectively. The Ln OR presented global homogeneity and significant values in > 75% of the studies. CONCLUSION: According to our meta-analysis, FDG-PET has high S and intermediate Sp, with few false negative results. These preliminary findings suggest that FDG-PET may be an effective means of identifying patients with recurrent ovarian cancer.

Carcinoma↗
PubMed2004

Epidemiology of constipation in North America: a systematic review.

OBJECTIVE: The aim of this study was to systematically review the published literature regarding prevalence, risk factors, incidence, natural history, and the effect on quality of life of constipation in North America. METHODS: A computer-assisted search of MEDLINE, EMBASE, and Current Contents databases was performed independently by two investigators. Study selection criteria included the following: (1) North American population-based sample of adults with constipation; (2) publication in full manuscript form in English; and (3) report on the prevalence, incidence, and natural history of constipation or impact of constipation on quality of life. Eligible articles were reviewed in a duplicate, independent manner. Data extracted were compiled in tables and presented in descriptive form. RESULTS: The estimates of the prevalence of constipation in North America ranged from 1.9% to 27.2%, with most estimates from 12% to 19%. Prevalence estimates by gender support a female-to-male ratio of 2.2:1. Constipation appears to increase with increasing age, particularly after age 65. No true population-based incidence studies or natural history studies were identified. In one cohort, 89% of patients with constipation still reported constipation at 14.7 months follow-up. From limited data, quality of life appears to be diminished by constipation, but the clinical significance of this is unclear. CONCLUSIONS: Constipation is very common, as approximately 63 million people in North America meet the Rome II criteria for constipation. Minimal data are available regarding incidence, natural history, and quality of life in patients with constipation. Effort should be expended toward the study of these topics, particularly in the elderly, who are disproportionately affected by this condition.

Constipation↗
PubMed1992

How to write and publish scientific papers: scribing information for pharmacists.

The principles of writing and publishing scientific papers are outlined. Scientific writing can be both professionally and financially rewarding, but many pharmacists hesitate to write for publication. A primary obstacle is not knowing how to begin. Thoughtful planning is the first and most important step. Before writing a word, the writer should identify the main message, audience, target journal, resource materials, type of manuscript, and authorship. The sections of a paper reporting original research include the title, abstract, introduction, methods, results, discussion, conclusion, references, and tables and figures. Some of these elements also appear in review papers and columns. In general, information given in one section should not duplicate information in another. The writer typically drafts the methods section first, followed by the results, the discussion, and the introduction. Along with intellectual responsibility for the paper, an author must assume various ethical responsibilities, such as ensuring that it contains no plagiarism, that all sources of funding have been acknowledged, and that the paper has not been simultaneously submitted to other journals. To enhance the likelihood of publication, the writer should edit the manuscript carefully and follow the target journal's instructions to contributors. Once the writer has submitted a paper, it must pass the muster of editors and, for peer-reviewed journals, outside experts. Several revisions may be requested before final acceptance. Pharmacists who adhere to the established pattern for writing and submitting scientific papers have the best chance of seeing their work in print.

Humans↗
PubMed1994

Interdisciplinary group approach to occupational safety and health administration standard: reductions in cost and duplication of effort.

After the December 1991 publication of the Occupational Safety and Health Administration standard, "Occupational Exposure to Bloodborne Pathogens; Final Rule," medical facilities in the United States were challenged to meet the mandates of this standard with massive training in a relatively short time. An interdisciplinary task force composed of representative members of a major health maintenance organization was charged with the task of developing a training plan for 11 Southern California medical centers and their 42 satellite medical offices. The task force ultimately developed, refined, and distributed a Trainer Guidebook that could be used by a variety of disciplines. This guidebook provided a method by which the information could be disseminated concisely, thoroughly, and promptly. The processes used in this project can be applied to other health care educational situations. The purpose of this article is to share these processes.

Cost Savings↗
PubMedDate not supplied

Randomized controlled trials in long-term care residents with dementia: a systematic review.

OBJECTIVE: To evaluate the quality of reporting of randomized controlled trials for pharmacologic interventions in long-term care residents with dementia. DATA SOURCES: We performed electronic searches of AMED, CINAHL, E-PSYCHE, Cochrane Controlled Trials Register, and MEDLINE. We also searched the reference lists of included studies and bibliographies of relevant review articles. STUDY SELECTION: All randomized controlled trials for pharmacologic interventions in patients with dementia residing in long-term care facilities. DATA ABSTRACTION: We abstracted data independently, in duplicate, using a data abstraction sheet and a quality checklist. DATA SYNTHESIS: Fifteen trials met inclusion criteria. Five trials lacked institutional ethical review, while two lacked informed consent. Eleven trials gave adequate description of withdrawals and 14 trials reported adverse events adequately. We found incomplete reporting of methods of randomization, allocation concealment, restriction, blinding, sample size estimation and intention-to-treat analysis. Sensitivity analysis indicated that reporting of allocation concealment was associated with increased quality of trial according to the quality scale (P = 0.007). CONCLUSIONS: Clinicians and the public do not have high-quality information to guide pharmacologic decision making for long-term care residents with dementia. The reporting quality is highly variable in the trials reviewed, and concerns exist surrounding the conduct of several trials.

Aged↗
PubMedDate not supplied

The Evolution of Developmental Mechanisms. Proceedings of a symposium. London, United Kingdom, January 2001.

In 1829, von Baer proposed four principles of development, the first of which states that the embryos of a large group of animals have most in common at early stages of development, the specialised features of different subgroups only emerging later. After the publication of Darwin's The Origin of Species in 1859, the relevance of von Baer's principles to evolution was clear to many biologists, who assessed evolutionary relationships on the basis of similarities and differences between early embryos. The validity of these comparisons, carried out more than a century ago, has been confirmed by recent molecular analyses. These new gene-based comparisons have in turn led to a renewed interest in the scientific literature of the first half of the 20th century, which documented in great detail comparative anatomical studies of living and fossil animals. The past decade has seen a growing synergy between developmental biology and evolutionary studies. As a result, not only is an evolutionary perspective now integral to developmental studies, but palaeontologists have become deeply interested in embryos. This integration was the subject of the symposium of the Winter Meeting of the Anatomical Society, held in London in January 2001, entitled 'The Evolution of Developmental Mechanisms'. It was a very stimulating and enjoyable meeting that addressed the theme at a number of levels, ranging from the major evolutionary changes resulting from gene duplication to the fine detail of insect wing vein evolution. These two ends of the spectrum of topics reflect Darwin's perspective on von Baer's principles, i.e. his recognition that homologies between different phyla are to be seen in early embryonic and larval structures, while adaptations that enable an organism to survive in its particular environment are the result of changes acting late in development. The reviews brought together in this volume represent a thoughtful and thought-provoking synthesis of data collected over many years. They show the rewards of detailed and long-term study of embryos that in some cases are difficult to obtain, but represent living clues to the mechanisms underlying important evolutionary transitions. We feel privileged to have had the responsibility for editing this impressive issue of the Journal of Anatomy, which will, we have no doubt, be a significant landmark in the ongoing story of development and evolution, and will be widely cited.

Animals↗
PubMed2005

Regulation of apoptosis by the papillomavirus E6 oncogene.

Infection with human papillomaviruses is strongly associated with the development of multiple cancers including esophageal squamous cell carcinoma. The HPV E6 gene is essential for the oncogenic potential of HPV. The regulation of apoptosis by oncogene has been related to carcinogenesis closely; therefore, the modulation of E6 on cellular apoptosis has become a hot research topic recently. Inactivation of the pro-apoptotic tumor suppressor p53 by E6 is an important mechanism by which E6 promotes cell growth; it is expected that inactivation of p53 by E6 should lead to a reduction in cellular apoptosis, numerous studies showed that E6 could in fact sensitize cells to apoptosis. The molecular basis for apoptosis modulation by E6 is poorly understood. In this article, we will present an overview of observations and current understanding of molecular basis for E6-induced apoptosis.

Amino Acid Sequence↗
PubMed1997

Selecting and appraising studies for a systematic review.

After thoroughly searching the potentially relevant literature for a systematic review, reviewers face the sequential tasks of selecting studies for inclusion and appraising these studies. Methodical, impartial, and reliable strategies are necessary for these two tasks because systematic reviews are retrospective exercises and are therefore prone to both bias and random error. To plan for study selection, reviewers begin with a focused clinical question and choose selection criteria that reflect this question. A detailed selection protocol that specifies the study designs and publication status of articles to be included is often helpful. Selection criteria are itemized on customized forms and are used to examine each potentially relevant primary study, usually by two different reviewers. In planning the critical appraisal of included studies, reviewers decide which clinical and methodologic study features require documentation. After choosing methods for evaluating study quality, reviewers construct customized appraisal forms and an explicit protocol for the actual evaluation. Some of the techniques commonly used to minimize the potential for error in study appraisal include duplicate, independent examination; blinding to study results and other identifying features of each article; and correspondence with study authors to clarify issues. Ultimately, primary studies should be selected, appraised, and reported in sufficient detail to allow readers to judge the applicability of the review to clinical practice and to clarify the strength of the inferences that can be drawn from the review.

Research Design↗
PubMed2000

The evolution of external quality evaluation: observations from the Joint Commission on Accreditation of Healthcare Organizations.

The Joint Commission on Accreditation of Healthcare Organizations, the oldest health care accrediting body in the world, currently accredits almost 20000 organizations in the USA. Although continuing to be professionally-sponsored, accreditation's rapid growth in recent years has been driven by the external users of accreditation--government, purchasers, and public--rather than by the original users, the professionals themselves. This experience in the USA suggests that over time successful external quality evaluation mechanisms throughout the world will involve representatives of the public, purchasers, and government in establishing standards and setting policies. Without this involvement, these stakeholders are unlikely to find the mechanisms credible in addressing their needs, and will seek alternatives--adding cost and duplication to the external quality evaluation system. Successful mechanisms are also likely to provide more detailed information about an organization's performance to the public, purchasers, and the government, while creating evaluation processes that provide for innovation and support improvement in efficiency, as well as quality, through incorporation of aspects of the Baldrige and European Foundation for Quality Management approaches to organizational excellence. Finally, successful evaluation mechanisms are likely to create a special focus on the safety of care, incorporating aspects of the International Organization for Standardization's ISO 9000 approach to quality management. While the specific nature, priority, and timing of these changes will differ from country to country, they are likely to influence the evolution of external quality evaluation throughout the world. External evaluation of health care organizations' quality holds great promise, but its long-term success depends on responding to all those who will want to depend on it.

Diffusion of Innovation↗
PubMed2005

Comparative study of apoptosis-related gene loci in human, mouse and rat genomes.

Many genes are involved in mammalian cell apoptosis pathway. These apoptosis genes often contain characteristic functional domains, and can be classified into at least 15 functional groups, according to previous reports. Using an integrated bioinformatics platform for motif or domain search from three public mammalian proteomes (International Protein Index database for human, mouse, and rat), we systematically cataloged all of the proteins involved in mammalian apoptosis pathway. By localizing those proteins onto the genomes, we obtained a gene locus centric apoptosis gene catalog for human, mouse and rat. Further phylogenetic analysis showed that most of the apoptosis related gene loci are conserved among these three mammals. Interestingly, about one-third of apoptosis gene loci form gene clusters on mammal chromosomes, and exist in the three species, which indicated that mammalian apoptosis gene orders are also conserved. In addition, some tandem duplicated gene loci were revealed by comparing gene loci clusters in the three species. All data produced in this work were stored in a relational database and may be viewed at http://pcas.cbi.pku.edu.cn/database/apd.php.

Animals↗
PubMed2004

Meta-analytic evidence of increased breakthrough bleeding during prophylaxis with B-domain deleted factor VIII.

A recent meta-analysis of 13 observational studies suggested reduced haemostatic efficacy during prophylaxis and shortened half-life of B-domain deleted factor VIII (BDD-rFVIII) as compared with full-length factor VIII (FL-FVIII). The meta-analysis included a multivariate model that took both dose and age into account. In addition, several assumptions and interpretations were required in order to conduct the meta-analysis. It is important to test the impact of such assumptions and interpretations through sensitivity analysis. In the published meta-analysis, results of several sensitivity analyses were described involving the effect of study design; heterogeneity of subjects in some studies; type of assay used for half-life determinations; and year of publication. In two subsequent brief reports, additional sensitivity analyses addressed choice of median-to-mean conversion factor over a wide range of scenarios and use of age at start of prophylaxis vs mean age during prophylaxis in the multivariate model. A recognized inherent difficulty in the meta-analysis of multiple published reports from similar studies is the possibility of some subject or data overlap. Therefore, the present communication details further sensitivity analyses encompassing assumptions regarding the possibility of subject duplication in a subgroup of subjects from one study and possible duplication of pharmacokinetic data from two smaller studies within the reports of two larger studies. All the sensitivity analyses support the main conclusions of the meta-analysis, namely, that BDD-rFVIII substantially increases the risk of breakthrough bleeding during prophylaxis, possibly at least partly because of shorter half-life than that of FL-FVIII.

Data Interpretation, Statistical↗
PubMed2004

Impact of informed consent requirements on cardiac arrest research in the United States: exception from consent or from research?

INTRODUCTION: Research in patients with life-threatening illness such as cardiac arrest is challenging since they can not consent. The Food and Drug Administration addressed research under emergency conditions by publishing new criteria for exception from informed consent in 1996. We systematically reviewed randomized trials over a 10-year period to assess the impact of these regulations. METHODS: Case-control study of published trials for cardiac arrest (cases) and atrial fibrillation (controls.) Studies were identified by using structured searches of MEDLINE and EMBASE from 1992 to 2002. Included were studies using random allocation in humans with cardiac arrest or atrial fibrillation prior to enrollment. Excluded were duplicate publications. Number of American trials, foreign trials and proportion of trials of American origin were compared by using regression analysis. Changes in cardiac arrest versus atrial fibrillation trials were calculated as risk differences. RESULTS: Of 4982 identified cardiac arrest studies, 57 (1.1%) were randomized trials. The number of American cardiac arrest trials decreased by 15% (95% CI: 8, 22%) annually (P = 0.05). The proportion of cardiac arrest trials of American origin decreased by 16% (95% CI: 10, 22%) annually (P = 0.006). Of 5596 identified atrial fibrillation studies, 197 trials (3.5%) were randomized trials. The risk difference between cardiac arrest versus atrial fibrillation trials being of American origin decreased significantly (annual difference -5.8% (95% CI: -10, -0.1%), P = 0.03). INTERPRETATION: Fewer American cardiac arrest trials were published during the last decade, when federal consent requirements changed. Regulatory requirements for clinical trials may inhibit improvements in care and threaten public health.

Atrial Fibrillation↗
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↗
PubMed2002

Human members of the eukaryotic protein kinase family.

BACKGROUND: Eukaryotic protein kinases (EPKs) constitute one of the largest recognized protein families represented in the human genome. EPKs, which are similar to each other in sequence, structure and biochemical properties, are important players in virtually every signaling pathway involved in normal development and disease. Near completion of projects to sequence the human genome and transcriptome provide an opportunity to identify and perform sequence analysis on a nearly complete set of human EPKs. RESULTS: Publicly available genetic sequence data were searched for human sequences that potentially represent EPK family members. After removal of duplicates, splice variants and pseudogenes, this search yielded 510 sequences with recognizable similarity to the EPK family. Protein sequences of putative EPK catalytic domains identified in the search were aligned, and a phonogram was constructed based on the alignment. Representative sequence records in GenBank were identified, and derived information about gene mapping and nomenclature was summarized. CONCLUSIONS: This work represents a nearly comprehensive census and early bioinformatics overview of the EPKs encoded in the human genome. Evaluation of the sequence relationships between these proteins contributes contextual information that enhances understanding of individual family members. This curation of human EPK sequences provides tools and a framework for the further characterization of this important class of enzymes.

Binding Sites↗
PubMed2004

Fluorides for the prevention of white spots on teeth during fixed brace treatment.

BACKGROUND: White spots can appear on teeth during fixed brace treatment because of early decay around the brace attachments. Fluoride is effective at reducing decay in susceptible individuals and is routinely prescribed in various different forms to patients during orthodontic treatment. OBJECTIVES: To evaluate the effectiveness of fluoride in preventing white spots during orthodontic treatment and to compare the different modes of delivery of fluoride. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (to 22 August 2002); CENTRAL (The Cochrane Library Issue 3, 2002); MEDLINE (January 1966 to July 2003); EMBASE (January 1980 to week July 2003). Authors of trials were contacted for further data. SELECTION CRITERIA: Trials were selected if they met the following criteria: a randomised or quasi-randomised clinical trial, involving the use of a fluoride-containing product compared with no use or use of a non-fluoride control and enamel demineralisation was assessed during or after orthodontic treatment. DATA COLLECTION AND ANALYSIS: Six reviewers independently, in duplicate, extracted data. The primary outcome was the difference in the presence or absence of white spots between experimental and control patients for parallel design studies, and between experimental and control quadrants, for split-mouth design studies. Potential sources of heterogeneity were examined. Sensitivity analyses were undertaken for the items assessed for quality and publication bias. MAIN RESULTS: The primary outcome of the review was the presence or absence of white spots by patient at the end of treatment. Secondary outcomes included any quantitative assessment of enamel mineral loss or lesion depth. Other outcomes such as differences in size and severity of white spots, any patient based outcomes, such as perception of white spots could not be included because there were insufficient data. Fifteen trials, with 723 participants, provided data for this review. None of the studies fulfilled all of the methodological quality assessment criteria. There is some evidence that a daily sodium fluoride mouthrinse reduces the severity of enamel decay surrounding a fixed brace (weighted mean difference for lesion depth -70.0; 95% CI -118.2 to -21.8) and that use of a glass ionomer cement for bracket bonding reduces the prevalence (Peto OR 0.35; 95% CI 0.15 to 0.84) and severity of white spots (weighted mean difference for mineral loss -645 vol%.microm; 95% CI -915 to -375) compared with composite resins. REVIEWERS' CONCLUSIONS: There is some evidence that the use of topical fluoride or fluoride-containing bonding materials during orthodontic treatment reduces the occurrence and severity of white spot lesions, however there is little evidence as to which method or combination of methods to deliver the fluoride is the most effective. Based on current best practice in other areas of dentistry, for which there is evidence, we recommend that patients with fixed braces rinse daily with a 0.05% sodium fluoride mouthrinse. More high quality, clinical research is required into the different modes of delivering fluoride to the orthodontic patient.

Dental Caries↗
PubMed2006

Chiropractic treatment of lower extremity conditions: a literature review.

OBJECTIVE: The purpose of this study was to document the quantity and type of research conducted on the chiropractic management of lower extremity conditions. METHODS: A review of the literature was conducted using the CINAHL, MEDLINE, MANTIS, and Science Direct databases (each from inception to December 15, 2005). Search terms included chiropractic, hip, knee, ankle, foot, with Medical Subject Heading terms for each region. Inclusion criteria included studies with a lower extremity diagnosis, and the treatment was performed by doctors of chiropractic. Articles were excluded if pain was referred from spinal sites and if there was a duplicate publication; articles published in non-peer-reviewed literature and abstracts in conference proceedings were also excluded. Of the articles identified, an analysis was conducted assessing those including peripheral and/or spinal treatment. Clinical trials were assessed for quality using the Physiotherapy Evidence Database scale. RESULTS: There was a total of 1652 citations. Of these, 76 were deemed relevant; 24 were related to the foot, 10 to the ankle, 25 to the knee, and 17 to the hip. Twenty-nine citations included spinal treatment, 47 solely peripheral, and 2 solely spinal. Ten citations were clinical trials and scored on the Physiotherapy Evidence Database scale. CONCLUSIONS: Literature on the chiropractic management of lower extremity conditions has a large number of case studies (level 4 evidence) and a smaller number of higher-level publications (level 1-3 evidence). The management available in the peer-reviewed literature is predominantly multimodal and contains combined spinal and peripheral components. Future chiropractic research should use higher-level research designs, such as randomized controlled trials.

Ankle↗
PubMed2005

The quality of nifedipine studies used to assess tocolytic efficacy: a systematic review.

OBJECTIVE: To assess the quality of studies of nifedipine used to treat spontaneous preterm labor. DESIGN: A systematic review of study quality using a novel validity assessment tool, examining method-specific and topic-specific items in the domains of selection, performance and measurement biases. DATA SOURCES: Medline (1996-2003), EMBASE (1996-2003), BIOSIS (1993-2003), Current Contents (1995-2003), DERWENT DRUGFILE (1983-2003), Cochrane Database of Systematic Reviews. Bibliographies of existing meta-analyses and systematic reviews of nifedipine as a tocolytic. METHODS OF STUDY SELECTION: Forty-five studies evaluating the effectiveness of nifedipine were identified. DATA EXTRACTION: Each study was assessed for 40 method-specific and topic-specific items of quality in duplicate using piloted data extraction forms. Disagreements between assessors were settled by consensus/arbitration. DATA SYNTHESIS: Very few of the studies complied with adequacy criteria of quality for either method-specific or topic-specific items. There was no improvement in quality over time. The quality of method-specific items was significantly poorer when compared with topic-specific items of quality overall (P<0.0001) and in the domains of selection bias (P<0.0001) and performance bias (P<0.0001). CONCLUSION: Studies of the effectiveness of nifedipine as a tocolytic are of poorer quality with respect to method-specific items than topic-specific items. These deficiencies should be highlighted in meta-analyses or systematic reviews which measure efficacy and should influence the generation of guideline statements or recommendations for the use of nifedipine as a tocolytic. A large randomized trial fulfilling the quality items is necessary to assess the real efficacy of nifedipine in preterm labor.

Female↗
PubMed2002

Melanoma information on the Internet: often incomplete--a public health opportunity?

PURPOSE: To assess the accuracy and completeness of information regarding melanoma on the Internet, retrieved by use of search engines. METHODS: The first 30 uniform/universal resource locators (URLs) from each of eight search engines using the search term "melanoma" were retrieved for evaluation of accuracy and completeness using a 35-point checklist rating system instrument. Four reviewers independently rated each of 35 sites, and one reviewer rated all 74 assessable sites. Kappa statistics were used to evaluate interrater variability. RESULTS: A total of 74 assessable Web sites were evaluated. The remainder were inaccessible, link pages only, or duplicates. Thirty-five Web sites were each independently rated by four reviewers. The remaining 39 Web sites were each rated by one reviewer. The mean kappa statistic for all variables and all rater pairs for which a kappa could be calculated was 0.824, indicating excellent overall inter-rater reliability. The majority of Web sites failed to include complete information on general information, risk factors, diagnosis, treatment, prevention, and prognosis. Ten Web sites (14%) contained a total of 13 inaccuracies, most relatively minor. CONCLUSION: Medical information retrieved with the search term melanoma was likely to lack complete basic melanoma information and contained inaccuracies in 14% of sites. Health care providers can help patients by recommending comprehensive and accurate Web sites for patient review, by working to create accurate and thorough Web-based health information material, and by educating patients and the public about the variability in completeness and accuracy.

Humans↗