Assessing the Accuracy and Readability of Online Health Information for Patients With Pancreatic Cancer.

IMPORTANCE: The degree to which patients are empowered by written educational materials depends on the text's readability level and the accuracy of the information provided. The association of a website's affiliation or focus on treatment modality with its readability and accuracy has yet to be thoroughly elucidated. OBJECTIVE: To compare the readability and accuracy of patient-oriented online resources for pancreatic cancer by treatment modality and website affiliation. DESIGN: An online search of 50 websites discussing 5 pancreatic cancer treatment modalities (alternative therapy, chemotherapy, clinical trials, radiation therapy, and surgery) was conducted. The website's affiliation was identified. Readability was measured by 9 standardized tests, and accuracy was assessed by an expert panel. MAIN OUTCOMES AND MEASURES: Nine standardized tests were used to compute the median readability level of each website. The median readability scores were compared among treatment modality and affiliation categories. Accuracy was determined by an expert panel consisting of 2 medical specialists and 2 surgical specialists. The 4 raters independently evaluated all websites belonging to the 5 treatment modalities (a score of 1 indicates that <25% of the information is accurate, a score of 2 indicates that 26%-50% of the information is accurate, a score of 3 indicates that 51%-75% of the information is accurate, a score of 4 indicates that 76%-99% of the information is accurate, and a score of 5 indicates that 100% of the information is accurate). RESULTS: The 50 evaluated websites differed in readability and accuracy based on the focus of the treatment modality and the website's affiliation. Websites discussing surgery (with a median readability level of 13.7 and an interquartile range [IQR] of 11.9-15.6) were easier to read than those discussing radiotherapy (median readability level, 15.2 [IQR, 13.0-17.0]) (P = .003) and clinical trials (median readability level, 15.2 [IQR, 12.8-17.0]) (P = .002). Websites of nonprofit organizations (median readability level, 12.9 [IQR, 11.2-15.0]) were easier to read than media (median readability level, 16.0 [IQR, 13.4-17.0]) (P < .001) and academic (median readability level, 14.8 [IQR, 12.9-17.0]) (P < .001) websites. Privately owned websites (median readability level, 14.0 [IQR, 12.1-16.1]) were easier to read than media websites (P = .001). Among treatment modalities, alternative therapy websites exhibited the lowest accuracy scores (median accuracy score, 2 [IQR, 1-4]) (P < .001). Nonprofit (median accuracy score, 4 [IQR, 4-5]), government (median accuracy score, 5 [IQR, 4-5]), and academic (median accuracy score, 4 [IQR, 3.5-5]) websites were more accurate than privately owned (median accuracy score, 3.5 [IQR, 1.5-4]) and media (median accuracy score, 4 [IQR, 2-4]) websites (P < .004). Websites with higher accuracy were more difficult to read than websites with lower accuracy. CONCLUSIONS AND RELEVANCE: Online information on pancreatic cancer overestimates the reading ability of the overall population and lacks accurate information about alternative therapy. In the absence of quality control on the Internet, physicians should provide guidance to patients in the selection of online resources with readable and accurate information.

Development and promotion of a national website to improve dissemination of information related to the prevention of mother-to-child HIV transmission (PMTCT) in Tanzania.

BACKGROUND: Websites that address national public health issues provide an important mechanism to improve health education and services in resource limited countries. This article describes the development, promotion and initial evaluation of a national website to increase access to information and resources about prevention of mother-to-child transmission of HIV (PMTCT) among healthcare workers and PMTCT stakeholders in Tanzania. METHODS: A participatory approach, involving the Tanzania Ministry of Health and Social Welfare (MOHSW) and key PMTCT stakeholders, was used to develop and manage the online PMTCT National Resource Center (NRC), http://pmtct.or.tz/ . The website was created with a content management system software system that does not require advanced computer skills and facilitates content updates and site management. The PMTCT NRC hosts related regularly updated PMTCT-related news, resources and publications. Website implementation, access and performance were evaluated over two years using Google Analytics data about visits, page views, downloads, bounce rates and location of visitors, supplemented by anecdotal feedback. RESULTS: Following its launch in July 2013, the PMTCT NRC website received a total of 28,400 visits, with 66,463 page views, over 2 years; 30 % of visits were from returning visitors. During year 1, visits increased by 80 % from the first to second 6 month period and then declined slightly (9-11 %) but remained stable in Year 2. Monthly visits spiked by about 70 % during October 2013 and January 2014 in response to the release and promotion of revised national PMTCT guidelines and training manuals. The majority of visitors came from primarily urban areas in Tanzania (50 %) and from other African countries (16 %). By year 2, over one-third of visitors used mobile devices to access the site. CONCLUSIONS: The successfully implemented PMTCT NRC website provides centralized, easily accessed information designed to address the needs of clinicians, educators and program partners in Tanzania. Ongoing involvement of the MOHSW and key stakeholders are essential ensure the website's growth, effectiveness and sustainability. Additional efforts are needed to expand use of the PMTCT NRC throughout the country. Future evaluations should examine the role of the website in supporting implementation of national PMTCT guidelines and services in Tanzania.

Future Telehealth and Telecare Reference Design based on IoT Technologies: From Remote Monitoring to Smart Collaborative Services with Decision Support.

The demographic changes are producing aging societies across the world, resulting in greater demands on the health and care systems due to age-related disabilities and chronic diseases. Efficient telehealth and telecare services are needed to control the corresponding expenditures, by supporting increased collaboration between different professional and involving informal health care providers, and by empowering the patients to manage their health and well-being. Emerging trial systems for remote patient monitoring present preliminary solutions not exempt of certain limitations. We propose a future eHealth reference system architecture and core components, aiming at secure, smarter and more collaborative telehealth and telecare services. The implicit cooperation between the so-far separated domains of consumer well-being services and public telehealth and telecare services will be beneficial for all parties.

[psychenet - The Hamburg Network for Mental Health]. / psychenet - das Hamburger Netz psychische Gesundheit.

With the research and development project psychenet: the Hamburg Network for Mental Health (2011 - 2015), the Federal Ministry of Education and Research contributes to strengthening healthcare regions in Germany by establishing new transsectoral cooperations and implementing evaluated innovations. More than 300 partners from research, health care, health industry and government in the Free and Hanseatic City of Hamburg are promoting innovative measures to improve the detection, diagnosis, and treatment for mental disorders. The main objective is to implement integrated healthcare networks based on evidence for effective treatment methods, deriving from high-quality research throughout five indications such as psychosis, depression, somatoform and functional syndromes, anorexia and bulimia and addiction illnesses in adolescence. Those networks are accompanied by additional measures, for example, for improving awareness, information and education for mental health, addressing occupational health or strengthening the participation of patients and their families suffering from mental illness.

An adaptive case management system to support integrated care services: Lessons learned from the NEXES project.

BACKGROUND: Extensive deployment and sustainability of integrated care services (ICS) constitute an unmet need to reduce the burden of chronic conditions. The European Union project NEXES (2008-2013) assessed the deployment of four ICS encompassing the spectrum of severity of chronic patients. OBJECTIVE: The current study aims to (i) describe the open source Adaptive Case Management (ACM) system (Linkcare®) developed to support the deployment of ICS at the level of healthcare district; (ii) to evaluate its performance; and, (iii) to identify key challenges for regional deployment of ICS. METHODS: We first defined a conceptual model for ICS management and execution composed of five main stages. We then specified an associated logical model considering the dynamic runtime of ACM. Finally, we implemented the four ICS as a physical model with an ICS editor to allow professionals (case managers) to play active roles in adapting the system to their needs. Instances of ICS were then run in Linkcare®. Four ICS provided a framework for evaluating the system: Wellness and Rehabilitation (W&R) (number of patients enrolled in the study (n)=173); Enhanced Care (EC) in frail chronic patients to prevent hospital admissions, (n=848); Home Hospitalization and Early Discharge (HH/ED) (n=2314); and, Support to remote diagnosis (Support) (n=7793). The method for assessment of telemedicine applications (MAST) was used for iterative evaluation. RESULTS: Linkcare® supports ACM with shared-care plans across healthcare tiers and offers integration with provider-specific electronic health records. Linkcare® successfully contributed to the deployment of the four ICS: W&R facilitated long-term sustainability of training effects (p<0.01) and active life style (p<0.03); EC showed significant positive outcomes (p<0.05); HH/ED reduced on average 5 in-hospital days per patient with a 30-d re-admission rate of 10%; and, Support, enhanced community-based quality forced spirometry testing (p<0.01). Key challenges for regional deployment of personalized care were identified. CONCLUSIONS: Linkcare® provided the required functionalities to support integrated care adopting an ACM model, and it showed adaptive potential for its implementation in different health scenarios. The research generated strategies that contributed to face the challenges of the transition toward personalized medicine for chronic patients.

4Children for parents and for midwives.

This article outlines the launch of a new website which will bring together the rich, but sometimes difficult to access, body of best practice, research and evidence, that parents and professionals need when dealing with children aged from birth-five. The article sets out the scale, type and quality of information that is available, highlights what midwives could helpfully share with parents to help them deal with their children's developments, and what they could access themselves to develop their practice and ensure they remain as up to date as possible with early years developments.

Calidad de la información sobre ejercicios en las páginas de Internet dirigida a sobrevivientes de cáncer de seno / Quality of the information on exercise found on websites aimed at breast cancer survivors

Objetivo. Describir la calidad de la información acerca de ejercicios en Internet dirigida a sobrevivientes de cáncer de seno. Método. El diseño del estudio es exploratorio descriptivo. Se evaluó la calidad de la información acerca de ejercicios en un total de 40 páginas de Internet: se utilizaron 3 instrumentos para evaluar la calidad de la información: Discern, InEje (calidad de la información de ejercicios) y FRES/Huertas. Resultados. Los porcentajes de los promedios obtenidos con respecto a la puntuación máxima posible para cada instrumento fueron: Discern 62,67%, InEje 15,23%, y FRES/Huertas 56,51%. Conclusión. La evidencia sugiere que es necesario mejorar la calidad de la información sobre ejercicios de las páginas de Internet en inglés y español para sobrevivientes de cáncer de seno (AU)

Goal: To analyze the changes produced by therapeutic massage on systemic autonomic activity by analyzing the modification of cardiac autonomic activity. Material and methods: A comparative study was performed on 15 women on the variability of heart rate variability (HRV) (RR interval) obtained by photoplethysmography for 2 20-minute sessions: control and massage. HRV was measured at 4 different times for periods of 5 minutes each. The massage session consisted of effleurage massage and wide-ranging sliding pressure. In addition, the participants had to fill out the well-being visual analogue scale (Well Being VAS) questionnaire immediately after the control and massage session. Results: The paired Student’s t-test was used to compare the results obtained. Pearson correlation coefficient was used to quantify the relationship existing between the different times in each one of the parameters. A statistically significant increase was observed in HRV (total power) as well as an increase in parasympathetic activity in the massage session during the last 5 minutes (relative to baseline) compared to control session. However, this response tends to decrease 5 minutes after its interruption/timeout. Finally, the Well Being VAS score shows a significant increase after the massage. However, its gain is not correlated to the changes in the physiological variables. Conclusions: The massage applied on healthy subjects affects the autonomic nervous system (AU)

The internet and the physician-patient relationship.

BACKGROUND: Since the emergence of the public Internet in the early 1990s, the healthcare industry has been struggling to understand how best to utilize this resource. During the last decade there has been an increase in both the interest and participation by healthcare providers in the Internet space, but many observers continue to push for more development of healthcare resources to better support the provider-patient relationship. QUESTIONS/PURPOSES: This paper will review the historical development of the Internet, the core concepts that have driven the emergence and evolution of the Internet as a mass medium of information exchange, and how the healthcare industry can harness the Internet to improve the provider patient relationship. WHERE ARE WE NOW?: The healthcare industry continues to lag behind other industries that have been transformed by the Internet. Numerous industries including travel, real estate, retail sales, and banking have migrated both comprehensive information resources and transactions to the Internet in order to improve efficiency and customer satisfaction. That same process is occurring now in the healthcare industry. Credible and comprehensive Information resources are beginning to mature. Transactions are still in their infancy, reflecting a continued concern about privacy and security. WHERE DO WE NEED TO GO?: We need to improve information resources to educate and inform patients. Improving the availability and credibility of information resources will empower patients to make better healthcare decisions and I contend will ultimately reduce the cost of delivering care. HOW DO WE GET THERE?: Orthopaedists must first recognize the value of information resources to the patient. Effective communication with patients is a critical component of providing healthcare services. All healthcare providers should reflect on the importance of developing an effective communications strategy for their own practice and consider the benefits of participating in efforts by professional organizations to improve existing information resources.

Collaborating across the pond: the diffusion of virtual communities for nursing education.

Over the past decade, there have been significant changes in nursing education, particularly in teaching practice. This change has fueled interest in developing new and innovative approaches to teaching and curriculum. This article describes the shared experiences of two nurse educators on opposite sides of the Atlantic Ocean who have spent the last 4 years immersed in the process of developing and diffusing virtual communities for nursing education. Diffusion of innovations theory is used as a framework for this narrative. Nurse educators should have an awareness of the phases, steps, and challenges that can be expected during the process of innovation diffusion, including implications for education practice.

Teaching and learning in virtual worlds.

This column explores virtual worlds and their use in nursing.

A public health Immunization Resource Web site for chiropractors: discussion of current issues and future challenges for evidence-based initiatives for the chiropractic profession.

The Immunization Information Resource Web site is provided as a public service by the Chiropractic Health Care Section of the American Public Health Association. The site compiles annotated bibliographies of citations from the scientific literature, as well as other authoritative peer-reviewed information sources on this topic. Our intent was to create a resource of information for health care professionals that is current, accurate, objective, evidence based, and as user-friendly as possible. This article describes the Internet-based Immunization Information Resource Web site developed and sponsored by the Chiropractic Health Care Section of the American Public Health Association and discusses current issues and future challenges for sustaining and further advancing such evidence-based initiatives for the chiropractic profession.