Quality of health and medical information on the Internet

This article examines some of the problems associated with health and medical information available via the Internet. An overview is provided of gateway services that seek to provide access to high quality materials. Quality principles for health and medical Internet-based materials are highlighted and suggestions are offered for evaluating sources of information retrieved via the Internet. The article concludes that, although there is undeniably a vast quantity of useful material available via the Internet, the principles of basing health care on the best available evidence still apply and potential users need to critically appraise any information they wish to use.     

Internet tools in the medical classroom

Summary: The Internet contains a vast amount of medically relevant information. In order to access this information, however, many networks require one to master applications written in UNIX, an operating system considered by many not to be user friendly. Although these tools may be available on the campus, it is difficult to teach their use unless there is some immediate benefit to the already busy user. From that standpoint, it is important for instructors to realize that common UNIX applications can be utilized as classroom tools to significantly enhance the learning experience by facilitating teacher/student communication. Also, whilst the student enjoys greater communication with the instructor (and with other students) he/she is also becoming adept at using information management tools.     

互联网医疗内涵及其对医疗服务流程的重塑

互联网医疗利用信息技术重塑了传统医疗活动的信息传递过程,形成了新兴的医疗服务业态。互联网医疗的核心在于利用技术手段,从医疗服务过程中提取人、财、物信息,让信息流动代替或减少实物流动,实现医疗活动的再组织,从而打破传统医疗服务活动的时空限制,实现医疗服务过程提速,提升医疗资源的可及性和配置效率。利用多级服务站模型对医疗活动进行建模,以此为基础分析了医疗服务的信息传递过程,从而提出了互联网医疗重塑诊疗服务的4种路径。最后,对互联网医疗的发展进行了展望。     

The role of psychology in the teaching of medical ethics: the example of informed consent

Summary: Over the past two decades, psychology has become well established in the medical curriculum. This paper argues that it has much to say about ethical issues, particularly informed consent. Because psychology addresses such areas as providing information, ensuring understanding of this information, identifying situations in which coercion occurs and assessing competence, its inclusion in the curriculum is justified on ethical as well as scientific grounds. This has several implications, including the allocation of resources, collaboration with health and clinical psychologists and the timing of the teaching.     

互联网医疗在社区的需求探讨

目的通过调查了解及分析居民和医护人员对互联网医疗的应用和需求情况,为合理开发互联网医疗社区层面平台提供数据支撑。方法选择北京市房山区某8家社区卫生服务中心针对就诊居民和医护人员开展问卷调查,居民和医护人员各发放100份问卷。结果居民接触过的互联网需求排序前5位:预约挂号,档案查询、化验,健康科普,家医签约,信息查询。居民希望通过互联网享受排名前5位的医疗服务:预约挂号,在线复诊,医保支付,信息查询,健康教育。医护对互联网医疗持积极参与态度。医护使用过的互联网医疗服务排序前5位:预约挂号、信息查询、健康档案、查询、健康科普教育。结论社区层面互联网医疗建设,需加大政府扶持力度,加强百姓宣传引导,对促进发展互联网医疗服务具有现实意义。     

基于Internet技术的远程医疗系统

在中低速公路上利用Ｉｎｔｅｒｎｅｔ的相关技术建立了一个实用的远程医疗系统。系统包括二个子系统：一是远程会诊系统;二是网上医疗资讯系统。使用ＮｅｔＭｅｔｉｎｇ进行远程医疗会诊是该系统的关键,它将共享白板,共享应用程序,传送远程视频图像等很好地集成在一起,因此通过白板进行文字交谈,利用办公自动化套件显示有关会诊病历资料,再利用声音、视频、图像进行进一步的信息交流,这种会诊方式是基本可行的。网上医疗资讯系统分三类信息处理模式,即常规信息发布、交互式信息处理和多媒体信息交流,其分设了求医指南、健康之友、药品咨询等栏目。     

因特网上医疗设备信息的快速查询

本文介绍了在因特网上利用WWW浏览器和搜索引擎等工具快速查询医疗设备信息的主要方法。     

Changes in moral reasoning and the teaching of medical ethics

Courses in medical ethics are becoming an integral part of many medical school curricula in Europe. At the medical school of the University of Copenhagen, a course on philosophy of medicine has been compulsory for all medical students since 1988. The effect of such courses on the ethical awareness and reasoning of medical students is not well understood and we have therefore found it of interest to study the effects of the Copenhagen course. For the study, we used a Danish version of the Defining Issues Test (DIT) which measures development in moral reasoning (Rest J R, 1979 Development in Judging Moral Issues. University of Minnesota Press, Minneapolis).
The study was conducted as a pre- and post-test study without a control group, and the subjects were all medical students attending the course in the autumn of 1993.
The results show that moral reasoning scores measured by the DIT increase significantly, and we argue that this increase can only be explained as an effect of the course.     

Ethical permission for the publication of routinely collected data

BACKGROUND: Data collected from undergraduate medical students for routine purposes on a non-consented basis, but subsequently perceived as being potentially valuable for research purposes, lie in an ethical grey area. Currently, such data appear to be used routinely without explicit consideration of ethical considerations. AIMS: This paper proposes a consistent framework that would permit the use of such data. It also provides an advance on current practice with regard to ethical considerations around the absence of consent. DISCUSSION: We argue that students should be informed of generic possible uses of such data and given the opportunity to opt out, that researchers should be able to analyse such data retrospectively, but should then seek ethical permission for publication, and that an ethics committee should determine if ethical practices have been upheld before giving permission for any study incorporating such data to be submitted for publication. FUTURE DIRECTIONS: It is hoped that these proposals will stimulate debate, and that the results of such debate will inform practice in medical schools and medical education publishing.     

Ethics and animal issues in US medical education

Increasing public and regulatory agency concern about a variety of animal protection issues that affect the field of medicine have made these issues increasingly relevant to medical school curricula. The purpose of this study was to assess the availability and forms of medical school training relating to ethical, conceptual, and societal concerns in the use of animals within the field of medicine and the perceived need for such training.
Questionnaire surveys were mailed to the Deans of the 125 accredited US medical schools, and completed by Deans or their designees within the same medical institution. Questionnaire recipients were informed that results would be compiled in a fashion that did not identify specific individuals or institutions.
Survey responses were obtained from 84 medical institutions (67% response). Sixty respondents (71%) indicated that their medical school offered or sponsored some type of activity related to ethical and conceptual concerns in the use of animals in medical research and training. Most schools (43) offered informal discussions/seminars relating to these issues, but nine schools offered full formal courses with up to 15 lectures on these topics. Programme content and perceived need for additional instruction varied greatly amongst respondents.
The results suggest a wide diversity amongst US medical schools in the availability and perceived importance of medical school training relating to ethical and conceptual concerns in the uses of animals in medicine. It is proposed that instruction in these areas be pursued with more concerted efforts to address the growing body of knowledge about non-human beings and the ethical implications of such knowledge.     

Doctor in the house: the Internet as a source of lay health knowledge and the challenge to expertise

This paper investigates the new and unique medium of the Internet as a source of information about health. The Internet is an inherently interactive environment that transcends established national boundaries, regulations and distinctions between professions and expertise. The paper reports findings from a qualitative study of households who routinely used the Internet to access health information and examines how it affected their health beliefs and behaviours. The public use of previously obscure and inaccessible medical information is placed in the context of the debate about deprofessionalisation. It is shown that it is the users of Internet information rather than authors orprofessional experts who decided what and how material is accessed and used. It is concluded that the Internet forms the site of a new struggle over expertise in health that will transform the relationship between the health professions and their clients.     

Context in medical education: the informal ethics curriculum

As some formal bioethics instruction has become the norm in American medical schools, a trend has emerged toward increased attention to context in both bioethics education and bioethical decision-making. A focus on classical dilemmas and a textbook knowledge of principles is yielding its previous dominance to permit a more detailed examination of ethical behaviour in actual practice in medicine. After documenting and analysing this emerging trend in bioethics education and its parallel in bioethics theory and research, we turn to the context of medical education itself to look beyond formal bioethics instruction to the ' informal curriculum ' that is so central to the moral development of medical students and residents.
A qualitative research strategy is being used to study the informal curriculum through analysing tape-recorded informal conversations students and residents have with their friends and colleagues at work about issues bearing on their professional development. Data presented are documenting 'the unwritten code' for medical students on a surgical clerkship and the senior residents' informal ways of producing a ' practical ethics of conduct ' that shapes understanding of what is good, skilful, and right on that surgical service. How conceptions of appropriate conduct are conveyed, rewarded and sanctioned also reveals how professional demeanour is taught, permitting discussion about what should be retained and what changed. The context in which ethical issues arise enhances understanding of ethical practice in medicine.     

Physician Internet medical information seeking and on-line continuing education use patterns

INTRODUCTION: Although physician Internet use patterns have been studied, little attention has been paid to how current physician learning and change theories relate to physician Internet information seeking and on-line learning behaviors. The purpose of this study was to examine physician medical information-seeking behaviors and their relevance to continuing education (CE) providers who design and develop on-line CE activities. METHODS: A survey concerning Internet use and learning was administered by facsimile transmission to a random sample of 2,200 U.S. office-based physicians of all specialties. RESULTS: Nearly all physicians have access to the Internet, know how to use it, and access it for medical information; the Internet's professional importance to physicians currently is in the area of professional development and information seeking to provide better care rather than for patient-physician communication. A particular patient problem was the most common reason for seeking information. The credibility of the source, quick and 24-hour access to information, and ease of searching were most important to physicians. Barriers to use included too much information to scan and too little specific information to respond to a defined question. DISCUSSION: The importance of the Internet to physician professional development is growing rapidly. Access to on-line continuing medical education must be immediate, relevant, credible, and easy to use. A sense of high utility demands content that is focused and well indexed. The roles of the CE provider must be reshaped to include helping physicians seek and construct the kind of knowledge they need to improve patient care.     

Attitudes of medical students to medical ethics in their curriculum

One hundred and one students at different levels of their medical education were surveyed as to their views about inclusion of medical ethics in their curriculum. The results showed that 88% of the students feel that medical ethics has a place in their curriculum, and 84% rated medical ethics to be of High to Critical Importance to good medical care. They tended to read infrequently about medical ethics, which they would like integrated at all levels of the curriculum, particularly the clinical years. The more senior students were less sensitive to ethical issues. The students mentioned only dramatic issues in their accounts of encounters with cases involving ethical issues. It is felt that a wide gap is left in the education of these students if medical ethics is not included in a positive way in their curriculum.     

Using attitude surveys in medical ethics research and teaching: the example of undergraduate willingness to treat HIV-infected patients

As a break from the usual lecture or case discussion to teach medical ethics, this paper reports on the utilization of attitudinal surveys in ethical areas where students face a choice of behaviours. The technique can stimulate students to better understand their own attitudes and hopefully motivate them to overcome resistance to more ethical but perhaps less desirable behaviours. However, the technique also serves as the basis for empirical ethical research. The first section of the paper provides background on the conceptualization of attitudes, their measurement, and the statistical techniques for their analysis. In the second section, the special characteristics of medical students as a study population and ethical considerations in surveying them are discussed. Thirdly, the author uses his work in researching and in teaching about students' willingness to treat patients infected with HIV as an example of survey and analytical techniques. Finally, methods for using surveys in the classroom are presented.     

A quackery with a difference-new medical pluralism and the problem of 'dangerous practitioners' in the United Kingdom

The figure of the 'miracle cure'-peddling quack pretending spectacular properties for worthless tonics is iconic. From their 19th century traveling wagon shows to their 21st century Internet spam scams, hucksters and cranks have been consistently targeted by health authorities as a danger to public health. Yet, in this paper, I argue that this is only one form that the problem of 'quackery' has taken in the past two centuries or so in the United Kingdom. Just as Roy Porter showed how the mid-19th century professionalization of medicine gave rise to a 'quackery with a difference' as a whole range of new medical movements-homoeopathy, hydropathy, medical botany, mesmerism-actively denounced allopathic or modern medicine, I will suggest that the late 20th century birth of 'complementary and alternative medicine' (CAM) has resulted in yet another transformation in quackery. By examining the ways in which regulatory authorities in the UK have come to address what is invariably described as a 'growing interest in CAM', I will show how the problem of quackery today is increasingly located in an ethical field of practitioner competency, qualifications, conduct, responsibility and personal professional development, almost (but not quite) regardless of the form of therapy in question.     

Using the Internet for postgraduate medical education.

Obtaining information from the Internet can be fun. As the Internet is unregulated, the quality of this information can vary enormously and time can be wasted searching poor quality websites. Despite this, use of the Internet for postgraduate medical education is increasing.     

An innovation in teaching ethics to medical students

There is growing agreement among the medical profession that medical ethics should be taught at undergraduate level. We present a model which can be taught in a way which is lively and entertaining, and which allows students to discuss ethical problems freely in small groups. This brief teaching package maximizes the learning experience. It could be used as part of a more extensive programme of ethics teaching.