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Problems and pitfalls in cardiac drug therapy.

Medical errors in the care of patients may account for 44,000 to 98,000 deaths per year, and 7,000 deaths per year are attributed to medication errors alone. Increasing awareness among health care providers of potential errors is a critical step toward improving the safety of medical care. Because today's medications are increasingly complex, approved at an accelerated rate, and often have a narrow therapeutic window with only a small margin of safety, patient and provider education is critical in assuring optimal therapeutic outcomes. Providers can use electronic resources such as Web sites to keep informed on drug-drug, drug-food, and drug-nutritional supplements interactions.

California↗

dbNEI: a specific database for neuro-endocrine-immune interactions.

OBJECTIVES: To construct a specific database for the neuro-endocrine-immune (NEI) interactions. METHODS/RESULTS: Version 1.0 database for neuro-endocrine-immune (dbNEI) serves as a web-based knowledge resource specific for the NEI systems. dbNEI collects 1,058 NEI related signal molecules, their 940 interactions and 72 affiliated tissues from the Cell Signaling Networks database, manually selects 982 NEI papers from PubMed, and gives links to 27,848 NEI generally related genes from UniGene database. NEI related information, such as signal transductions, regulations and control subunits, is integrated. Especially, dbNEI represents as graphic visualization, by which control subunits can be automatically obtained according to the inquiring issues, the combinative queries and the NEI related diseases respectively. CONCLUSIONS: dbNEI, which can be accessed at http://bioinfo.au.tsinghua.edu.cn/dbNEIweb/, provides a knowledge environment for understanding the main regulatory systems of NEI in a molecular level.

Animals↗

Rapid response teams can help reduce mortality, 'code' rates.

Process gets help to patients further upstream, to detect signs of deterioration earlier. Takes about six months to begin to see real results from rapid response teams. Web site offers resources to quality managers interested in learning more about the program.

Critical Care↗

DHNet: a model for international research collaboration.

Internet technology has changed the way information is accessed, shared, and stored. This technology has supported the growth of scientific networks based on the need for improved communications and a team approach to problem solving. Scientists throughout the world are now able to come together in "virtual laboratories" or "collaboratories" to conduct research, analyze data, and discuss findings in a more timely and cost-efficient manner. The DHNet is based on a collaboratory model. It is a Web-based Internet resource designed to encourage research collaboration among dental hygiene professionals without regard to geographic location. The DHNet creates an electronic infrastructure that facilitates the linking, relating, and clustering of concepts that are critical to advancing a body of knowledge. It also creates a new standard for placing information on the Internet, which currently lacks conventions and structures for knowledge management. Designed to be maintained by its users with minimal staff support, the DHNet provides a mechanism for electronic publication of clinical observations, research, research in progress, and other document/media types. DHChat, the discussion forum component, provides an electronic communications tool for discussing topics of interest, research questions, and ways in which researchers would like to work together. Depending on the nature of the investigation, multi-site studies can be conducted or researchers can be responsible for different aspects of the same study. Video conferencing from desktop computers now permits synchronous discussion, enabling participants to see each other and work on the same document. The purposes of this article are to discuss the design of the DHNet as a model for supporting international research collaboration, and to discuss issues related to the use of electronic technology.

Computer Communication Networks↗

iHOPerator: user-scripting a personalized bioinformatics Web, starting with the iHOP website.

BACKGROUND: User-scripts are programs stored in Web browsers that can manipulate the content of websites prior to display in the browser. They provide a novel mechanism by which users can conveniently gain increased control over the content and the display of the information presented to them on the Web. As the Web is the primary medium by which scientists retrieve biological information, any improvements in the mechanisms that govern the utility or accessibility of this information may have profound effects. GreaseMonkey is a Mozilla Firefox extension that facilitates the development and deployment of user-scripts for the Firefox web-browser. We utilize this to enhance the content and the presentation of the iHOP (information Hyperlinked Over Proteins) website. RESULTS: The iHOPerator is a GreaseMonkey user-script that augments the gene-centred pages on iHOP by providing a compact, configurable visualization of the defining information for each gene and by enabling additional data, such as biochemical pathway diagrams, to be collected automatically from third party resources and displayed in the same browsing context. CONCLUSION: This open-source script provides an extension to the iHOP website, demonstrating how user-scripts can personalize and enhance the Web browsing experience in a relevant biological setting. The novel, user-driven controls over the content and the display of Web resources made possible by user-scripts, such as the iHOPerator, herald the beginning of a transition from a resource-centric to a user-centric Web experience. We believe that this transition is a necessary step in the development of Web technology that will eventually result in profound improvements in the way life scientists interact with information.

Computational Biology↗

Developing a Web-based education and counseling program for heart failure patients.

This paper describes a 2-phase method utilized to develop and evaluate the feasibility of a Web-based program targeted to the specific learning needs of elderly patients with heart failure. In the first phase, informational resources specific to the needs of elderly patients were identified using aspects of participant-focused research. Data from 69 patients were obtained through a structured interview and later reviewed with health care providers and patient representatives. Items deemed important by the patients and health care providers were incorporated into the Internet-based program that was drafted for the study. The second phase of the process entailed obtaining data to support the acceptability and feasibility of the intervention by providing 12 patient volunteers access to the Internet-based program that was developed. After 2 weeks, the authors contacted the volunteers and asked them about their experiences with accessing and navigating the Web page. The authors found that elderly persons with limited computer skills can and will use Web resources to obtain information when given adequate instructions on how to access the Web pages.

Aged↗

Virtual resource development in the glycosciences.

The development of Internet-based virtual resources is a relatively new area of scientific and technical activity that is currently undergoing rapid expansion. Major factors fuelling recent growth include the emergence of multimedia capabilities through the rapid evolution of the World Wide Web, the reduction in cost of high quality personal computers and graphics workstations and the provision of mass-marketed provider services. Prior to 1995 the presence of Internet resources in the glycosciences was virtually non-existent. Existing scientific knowledge was primarily made available on the Net through the provision of databases from gopher and ftp sites. A particular example in the glycosciences is the Carbbank database of biological carbohydrate sequences. We will describe here our efforts in 1994-95 in establishing The Glycoscience Network (TGN, http:@ bellatrix.pcl.ox.ac.uk/TGN/). These activities included the establishment of a newsgroup, mailing lists, Web resources and the running of the First Electronic Glycoscience Conference (EGC-1, http:@bellatrix.pcl.ox.ac.uk/egc/). EGC-1 included many novel initiatives in the glycosciences including electronic posters and papers, a Virtual Conference Centre, a Web-based hyperglossary, Virtual Trade and Employment Centres, refereed electronic publishing, and the creation of a Virtual Reality Gallery. We would like to look towards the near future and discuss several initiatives in virtual resource creation that we believe will have significant scientific impact on the glycosciences including the development of bioinformatics-based servers, sophisticated interactive databases, and videoconferencing. Furthermore, we cherish the belief that these resources will foster international scientific collaboration and progress of an extent never previously possible. Finally, we indulge in speculation and make some suggestions on the form and long-term impact of Glycoscience Virtual Resources. We predict that their development may completely reconstruct the scientific environment that we work in as scientists and we reflect on the probable benefits and pitfalls to be encountered.

Carbohydrates↗

Evaluating the source and content of orthopaedic information on the Internet. The case of carpal tunnel syndrome.

BACKGROUND: The Internet has become a popular source of medical information for patients. Authors of health-related web pages are not required to adhere to any standard for medical content or accuracy. The goal of the present study was to assess the type, quality, and reliability of information about carpal tunnel syndrome that is available on the Internet. METHODS: The search phrase "carpal tunnel syndrome" was entered into five commonly used World Wide Web search engines. The search results then were given as an ordered list of universal resource locators, or web-site addresses. The top (first) fifty web sites from each of the five searches were combined to create a master roster of 250 web-site addresses. These web sites then were evaluated for authorship and content, and an informational value score ranging from 0 to 100 points was assigned to each. RESULTS: Thirty-three percent of the sites sold commercial products for the evaluation or treatment of carpal tunnel syndrome. An additional 30 percent were commercial web sites that did not sell products. Only 23 percent of the sites were authored by a physician or an academic organization. Fewer than half of the sites offered conventional information. Twenty-three percent of the sites offered unconventional or misleading information. The mean informational value of the web sites was 28.4 of a possible 100 points. CONCLUSIONS: The information about carpal tunnel syndrome on the Internet is of limited quality and poor informational value. The public and the medical communities need to be aware of these limitations so that the quality of medical information available on the World Wide Web can be improved.

Carpal Tunnel Syndrome↗

How to use and cite Internet resources, with special attention to radiation protection and health physics WWW sites.

This paper describes an Internet search for the phrases radiation protection and health physics using major search engines and discusses the search procedure and the related problems. Depending on the search engine used, the number of hits ranged from 10,000 to only 17. The author presents some of the most relevant Web sites for radiation protection and health physics, and gives their URLs. As expected, these are mainly the sites of major national and international organizations. The author discusses a model for citation of WWW resources and refers to Internet links where this issue has been elaborated in more detail. Numerous links to various institutions and Web resources are given as well.

Computer Communication Networks↗

Web pages: an effective method of providing CAI resource material in histology.

Increased student numbers and the recognition that computer skills are essential for medical students led to the introduction of computer-aided instruction (CAI) resource material as an integral part of the second-year histology course at the University of Natal (South Africa) Medical School. Several copies of a commercial software package (compact disc-CD) covering the entire course were available. During the course of the year, using the physical and human resources available, the first in-house software package ('The Integumentary System') was generated in MS Word and saved as a series of linked html documents. The package could be accessed simultaneously by all students via the local area network (LAN). As part of an extensive evaluation of the introduction of CAI in histology, student comments and criticisms of the commercial and in-house package were canvassed. The response regarding the in-house software was encouraging, with students perceiving that it met their educational needs, preferring it to the commercial package. This report describes the ease with which this software can be developed, using limited resources and available skills, while providing students with valuable learning opportunities.

Journal Article↗

Unweaving the Web: an exploratory study of low-literate adults' navigation skills on the World Wide Web.

For traditionally underserved populations, the Web can potentially unlock resources that could fundamentally improve health and wellbeing. However, there are many barriers to using Web-based content. While physical access issues are well documented, there is little understanding of how nonmainstream populations use or will use the Web. Based on an ethnographic study of a group of low-literate adults, we have identified specific navigational and content issues that present barriers to this population. We discuss preliminary assumptions that can be used to inform the development of Web tools for this target audience, and directions for future applied research.

Adult↗

The Factor VIII Mutation Database on the World Wide Web: the haemophilia A mutation, search, test and resource site. HAMSTeRS update (version 3.0).

The HAMSTeRS WWW site was set up in 1996 in order to facilitate easy access to, and aid understanding of, the causes of haemophilia A at the molecular level; previously, the first and second text editions of the database have been published in Nucleic Acids Research. This report describes the facilities originally available at the site and the recent additions which we have made to increase its usefulness to clinicians, the molecular genetics community and structural biologists interested in factor VIII. The database (version 3.0) has been completely updated with easy submission of point mutations, deletions and insertions via e-mail of custom-designed forms. The searching of point mutations in the database has been made simpler and more robust, with a concomitantly expanded real-time bioinformatic analysis of the database. A methods section devoted to mutation detection has been added, highlighting issues such as choice of technique and PCR primer sequences. Finally, a FVIII structure section gives access to 3D VRML (Virtual Reality Modelling Language) files for any user-definable residue in a FVIII A domain homology model based on the crystal structure of human caeruloplasmin, together with secondary structural data and a sound+video animation of the model. It is intended that the general availability of this model will assist both in interpretation of causative mutations and selection of candidate residues forin vitromutagenesis. The HAMSTeRS URL is http://europium.mrc.rpms.ac.uk.

Computer Communication Networks↗

Three options for citation tracking: Google Scholar, Scopus and Web of Science.

BACKGROUND: Researchers turn to citation tracking to find the most influential articles for a particular topic and to see how often their own published papers are cited. For years researchers looking for this type of information had only one resource to consult: the Web of Science from Thomson Scientific. In 2004 two competitors emerged--Scopus from Elsevier and Google Scholar from Google. The research reported here uses citation analysis in an observational study examining these three databases; comparing citation counts for articles from two disciplines (oncology and condensed matter physics) and two years (1993 and 2003) to test the hypothesis that the different scholarly publication coverage provided by the three search tools will lead to different citation counts from each. METHODS: Eleven journal titles with varying impact factors were selected from each discipline (oncology and condensed matter physics) using the Journal Citation Reports (JCR). All articles published in the selected titles were retrieved for the years 1993 and 2003, and a stratified random sample of articles was chosen, resulting in four sets of articles. During the week of November 7-12, 2005, the citation counts for each research article were extracted from the three sources. The actual citing references for a subset of the articles published in 2003 were also gathered from each of the three sources. RESULTS: For oncology 1993 Web of Science returned the highest average number of citations, 45.3. Scopus returned the highest average number of citations (8.9) for oncology 2003. Web of Science returned the highest number of citations for condensed matter physics 1993 and 2003 (22.5 and 3.9 respectively). The data showed a significant difference in the mean citation rates between all pairs of resources except between Google Scholar and Scopus for condensed matter physics 2003. For articles published in 2003 Google Scholar returned the largest amount of unique citing material for oncology and Web of Science returned the most for condensed matter physics. CONCLUSION: This study did not identify any one of these three resources as the answer to all citation tracking needs. Scopus showed strength in providing citing literature for current (2003) oncology articles, while Web of Science produced more citing material for 2003 and 1993 condensed matter physics, and 1993 oncology articles. All three tools returned some unique material. Our data indicate that the question of which tool provides the most complete set of citing literature may depend on the subject and publication year of a given article.

Journal Article↗

Practical considerations for exploiting the World Wide Web to create infobuttons.

BACKGROUND: We are studying ways to provide automated, context-specific links (called "infobuttons") between clinical information systems (CIS) and other information resources available on the World Wide Web. As part of this work, we observed the information needs that arose when clinicians used a CIS and we classified those needs into generic questions. We then sought general methods for accessing information resources to answer the questions. METHODS: For each generic question, we identified a satisfactory resource and then developed a method for retrieving from it the information relevant to the question. We then studied these methods to characterize them into general approaches. RESULTS: We identified six general approaches and describe them in detail. These approaches range in complexity from simple, hard-coded links to intelligent agents and calculators. CONCLUSION: Web-based information resources can be exploited using a relatively small number of methods, although the specific methods require custom solutions. Standard methods for accessing Web-based resources would simplify the task of linking to CISs.

Decision Support Systems, Clinical↗

Sharing infobuttons to resolve clinicians' information needs.

Attempts to link clinical information systems to on-line information resources date back over a decade. The World Wide Web presents new opportunities to create such links, which we refer to as "infobuttons". This capability is partly due to the ease with which a link (called a Uniform Resource Locator, or URL) in one Web-based system can take users to another Web-based system, and partly due to the proliferation of high-quality Web-based resources. Typically, contextual information from the clinical system (such as patient data) is passed to a search engine that is evoked and, in turn, presents search results to the user. Impediments to infobutton development include customized programming to pass context information to the information resource, lack of standards for types and values of context information, variability of search engine interfaces, and a lack of understanding of clinicians' information needs. We are addressing these limitations with an Infobutton Manager (IM) that provides a standardized interface for matching user contexts to information resources.

Hospital Information Systems↗

Sources of information on postgraduate medical training programs - 2004 update.

This is the biennial update listing directories, journal articles, Web sites, and general books that aid the librarian, house officer, or medical student in finding information on medical residency and fellowship programs. The World Wide Web provides the most current and complete source of information about postgraduate training programs and specialties. This update goes beyond postgraduate training resources to include selected Web sites and books on resume writing, practice management, personal financial issues, the "Match," exam preparation, job hunting, and the DEA license application process. Print resources are included if they provide information not on the Internet or have features that are particularly useful. The Internet continues to be a major marketing tool for hospitals seeking to recruit the best and brightest for their residency and fellowship programs. Even the smallest community hospital usually has a presence on the 'Net.

Education, Medical, Graduate↗

AraCyc: a biochemical pathway database for Arabidopsis.

AraCyc is a database containing biochemical pathways of Arabidopsis, developed at The Arabidopsis Information Resource (http://www.arabidopsis.org). The aim of AraCyc is to represent Arabidopsis metabolism as completely as possible with a user-friendly Web-based interface. It presently features more than 170 pathways that include information on compounds, intermediates, cofactors, reactions, genes, proteins, and protein subcellular locations. The database uses Pathway Tools software, which allows the users to visualize a bird's eye view of all pathways in the database down to the individual chemical structures of the compounds. The database was built using Pathway Tools' Pathologic module with MetaCyc, a collection of pathways from more than 150 species, as a reference database. This initial build was manually refined and annotated. More than 20 plant-specific pathways, including carotenoid, brassinosteroid, and gibberellin biosyntheses have been added from the literature. A list of more than 40 plant pathways will be added in the coming months. The quality of the initial, automatic build of the database was compared with the manually improved version, and with EcoCyc, an Escherichia coli database using the same software system that has been manually annotated for many years. In addition, a Perl interface, PerlCyc, was developed that allows programmers to access Pathway Tools databases from the popular Perl language. AraCyc is available at the tools section of The Arabidopsis Information Resource Web site (http://www.arabidopsis.org/tools/aracyc).

Arabidopsis↗