"中国远程病理中心"网站与远程医学病理学教育

远程病理学 (ｔｅｌｅｐａｔｈｏｌｏｇｙ)是指在异地之间共同进行的病理学实践 ,包括病理会诊、病理学教育、科研和学术交流 ,并通过国际互联网查找各种病理学信息资源等 ,这种活动已通过远程多媒体计算机通信技术得以实现。“中国远程病理中心”网站系国家自然科学基金资助项目 ,已于 2 0 0 0年 4月正式开通 ,该网站目前已成国内远程病理学实践的重要工具之一。远程医学病理学教育是远程病理学中十分重要的组成部分 ,是该网站的重要栏目。笔者重点介绍如何利用“中国远程病理中心”网站接受远程医学病理学教育。1　远程医学病理学教育栏目…     

在“中国远程病理中心”网站开展远程病理会诊

“中国远程病理中心”网站（www.cipc.org.cn)为国内病理科医生提供了一个进行远程病理会诊的互联网平台。本文对在该网站上进行病理会诊的方法及注意事项进行介绍。通过1年多86例远程病理会诊证明，在网站上进行远程病理诊断具有很高的准确性和安全性，可以用于临床病理诊断和医学继续再教育。     

"中国远程病理中心"网站开通

国家自然科学基金和福建省重大科技项目基金资助的“中国远程病理中心”网站 ,域名ｗｗｗ .ｃｉｐｃ .ｏｒｇ .ｃｎ ,于 2 0 0 0年春节正式开通。这是国内首家正式的大型远程病理专业网站 ,具有远程病理会诊、专题进修、病理学产品介绍及讨论会等 30多项栏目 ;凡国内外病理界专业人士及与病理学有关的厂商都能注册、免费发表自己的文章及图像 ,空间不限。欢迎大家使用。该中心将于今年下半年举办两期“远程病理学习班” ,学员每人一台电脑上网 ,学习各种远程病理学操作技巧。有意参加者请与福州市南京军区福州总医院病理科郑智勇、余英豪联…     

介绍“中国远程病理中心”网站的重点栏目远程医学病理学再教育

远程医学病理学教育栏目是“中国远程病理中心”网站的重要组成部分，其作用已越来越受到国内病理界的承认与关注，并受到广大基层临床病理工作者的认可。本文就“中国远程病理中心”网站中远程医学病理学教育栏目进行介绍。     

远程病理学在病理诊断中的研究进展

远程病理（telepathology）即采用计算机技术以及传输影像的远程通讯技术,对远距离病理图像进行观察、分析和诊断的一门新型学科,是远程医学的一个重要分支。目前国内已有少数医学机构接受这种诊断方式。Weinstein等曾记录了1959年在相隔9km的距离通过同轴光缆传输的方式进行远程放射学实验,为远程病理的研究奠定了基础。1973年该学者又报道了在巴西和华盛顿之间通过卫星传输形式进行外周血和骨髓涂片的黑白照片的会诊,远程病理研究进入了临床试验阶段。1986年美国芝加哥大学的一个研究小组,利用自动化显微镜、摄像机、计算机等硬件和远程通讯技术建立了世界上第一个动态即时远程病理工作站,并在利用卫星传输病理学图片方面获得成功。1989年,法国建立了用电话线传输信息的静态远程病理学网络。1990年挪威的远程病理网络工作站为5家没有外科病理学的医院建立了远程冷冻服务技术。20世纪90年代中期,随着PC计算机的发展,远程病理工作站的费用相对降低,远程病理得到了飞速的发展。本文就远程病理在诊断病理学中的诊断模式、临床试验以及发展前景等方面加以阐述。     

构筑基于Web技术的远程医疗网的方案研究

本文针对基本Web技术的远程医疗系统的构筑问题，尝试采用网站形式建立基于浏览器／服务器模式（Browser/Server)的远程医疗会诊系统，希望通过使用高效率的Java语言编程，使用户能够只需使用一个WWW浏览器，就可以达到实现远程医疗会诊的目的。     

中华医学会妇科肿瘤学分会妇科肿瘤组织与细胞病理学会诊中心在北京成立

为了适应妇科肿瘤学快速发展的形势和需要，中华医学会妇科肿瘤学分会决定委托解放军总医院设立“中华医学会妇科肿瘤学分会妇科肿瘤病理与细胞学会诊中心”（以下简称会诊中心）。聘任解放军总医院病理科陈乐真教授担任中心主任，韦立新教授兼任中心副主任，同时聘任国内数家医院妇科肿瘤病理学家担任会诊专家。会诊中心附设在解放军总医院病理科，主要承担以下工作：（1）会诊工作：进行妇科肿瘤的组织病理学和细胞病理学日常会诊；     

利用"中国远程病理中心"进行国际互联网医学资源检索

“中国远程病理中心”网站主页上的检索园地栏目中链接了大量的国内外医药期刊学杂志、病理学网页和医学网络搜索器、数据库的网址，由此进入可以方便地查找国际互联网中的各种医学资料，检索到全世界范围内的各种有关医学的网上资料如文献、教科书、图像、多媒体教学、新闻等内容。本文重点介绍如何利用该网站进行国际互联网医学资源检索。     

地市级医院292例远程病理会诊病例分析

目的探讨远程病理会诊在帮助解决地市级医院疑难病理诊断和病理质量控制问题中的应用价值。方法回顾292例远程病理会诊病例,分析会诊病例的系统分布特点,计算远程病理会诊确诊率及获得报告的时长等指标,评价远程病理会诊在帮助解决基层医院病理科疑难病理诊断与质量控制中的应用价值。结果会诊病例中占前五位的分别是妇产科(62/292、21.23%)、软组织(34/292、11.64%)、淋巴造血系统(26/292、8.90%)、呼吸系统(19/292、6.51%)、皮肤(18/292、6.16%)。会诊病例最快可在30 min内获得会诊报告,88.7%(259/292)的病例可在48 h内获得会诊报告,获得会诊报告的平均时长约12 h。292例远程病理会诊病例的总体确诊率为90.07%(263/292),其中首次会诊的确诊率为69.86%(204/292);20.2%(59/292)的病例接受专家建议进行免疫组化或特殊染色检测,经检测后均获得确诊;仅有0.34%(1/292)的病例经多点会诊后仍存在良恶性诊断分歧。结论远程病理会诊可提供准确、及时的专家咨询病理报告,帮助提高基层医院病理诊断水平,值得在基层医院病理科推广应用。建设和发展区域远程病理会诊平台是一个新的病理质量控制发展方向。     

远程医疗会诊在我院应用过程的探讨

远程医疗会诊是利用远程通讯和信息技术，实现会诊的目的。本文从观念、会诊程序、会诊费用三个方面进行了探讨，以利于我院远程医疗会诊的长期发展。     

It's good to talk: comparison of a telephone helpline and website for cancer information

The Internet plays an important role in the information gathering process for people affected by cancer. This paper presents the results of a study comparing two sources of cancer information; a website and a telephone helpline. Data were captured on the use of one section of the UK charity CancerBACUP's website, and systematically compared to data collected from every fifth user of the charity's helpline. Subjects of enquiry for 994 telephone enquiries and 3096 web enquiries were comparable. The majority of enquiries to both services were about women and/or patients aged 50 or older. Website users were more likely than helpline users to request factual information and less likely to request information on sensitive topics. This study provides valuable information about the types of health information people seek from different sources and how the sources may complement each other.     

利用ASPmaker快速开发中国透析移植学会（CDTA）网站

以中国透析移植学会网站开发过程为例，介绍利用ASPmaker快速开发基于ASP技术医学网站的方法。ASPmaker的应用，不仅加快了ASP网站开发过程，而且降低了技术难度，使广大医务工作者也能参与医学网站的开发建设。     

Evaluation of the quality and readability of online information about breast cancer in China

ObjectiveThis study aimed at evaluating the quality and readability of online information about breast cancer written in Chinese.MethodsAn Internet search was conducted for “breast cancer” in Chinese using the Baidu search engine. Website quality was evaluated using the DISCERN instrument, and readability was evaluated using the Chinese Readability Index Explorer (CRIE). Higher DISCERN score indicated higher quality of websites, while higher CRIE score indicated lower readability of the content of the websites. We also investigated the effects of website producer category, and the associations of search engine ranking with DISCERN and CRIE scores.ResultsA total of 49 websites were included. The mean overall DISCERN score was 50.27 ± 4.14, and the mean CRIE score was 6.78 ± 0.16. Websites produced by non-profit organizations had the highest overall DISCERN scores, while those produced by private individuals had the lowest CRIE scores. Search engine ranking had no significant correlation with website quality or readability.ConclusionsThe quality and readability of breast cancer websites in Chinese were not satisfactory, and they varied among different website producer categories.Practice implicationsWebsite producers should seek to provide more accurate, comprehensive, and easy-to-understand information to better meet the needs of breast cancer patients. In addition, search engines should revise algorithms to promote websites with higher quality and accessibility.     

Prospective associations between intervention components and website engagement in a publicly available physical activity website: the case of 10,000 Steps Australia

Background

Effectiveness of and engagement with website-delivered physical activity interventions is moderate at best. Increased exposure to Internet interventions is reported to increase their effectiveness; however, there is a lack of knowledge about which specific intervention elements are able to maintain website engagement.

Objective

To prospectively study the associations of website engagement and exposure to intervention components for a publicly available physical activity website (10,000 Steps Australia).

Methods

Between June and July 2006 a total of 348 members of 10,000 Steps completed a Web-based survey to collect demographic characteristics. Website engagement was subsequently assessed over a 2-year period and included engagement data on website components; individual challenges, team challenges, and virtual walking buddies; and indicators of website engagement (average steps logged, days logging steps, and active users).

Results

On average participants logged steps on 169 (SD 228.25) days. Over a 2-year period this equated to an average of 1.6 logons per week. Binary logistic regression showed that individuals who participated in individual challenges were more likely to achieve an average of 10,000 steps per day (odds ratio [OR] = 2.80, 95% confidence interval [CI] 1.45–5.40), log steps on a higher than average number of days (OR = 6.81, 95% CI 2.87–13.31), and remain an active user (OR = 4.36, 95% CI 2.17–8.71). Additionally, those using virtual walking buddies (OR = 5.83, 95% CI 1.27–26.80) and of older age logged steps on a higher than average number of days. No significant associations were found for team challenges.

Conclusions

Overall engagement with the 10,000 Steps website was high, and the results demonstrate the relative effectiveness of interactive components to enhance website engagement. However, only exposure to the interactive individual challenge feature was positively associated with all website engagement indicators. More research is needed to examine the influence of intervention components on website engagement, as well as the relationship between website engagement and physical activity change.     

Initial and sustained participation in an internet-delivered long-term worksite health promotion program on physical activity and nutrition

Background

Determinants of participation in health promotion programs are largely unknown. To evaluate and implement interventions, information is needed regarding their reach as well as regarding the characteristics of program users and non-users.

Objective

In this study, individual, lifestyle, and health indicators were investigated in relation to initial, and sustained participation in an Internet-delivered physical activity and healthy nutrition program in the workplace setting. In addition, determinants of program website use were studied.

Methods

Determinants of participation were investigated in a longitudinal study among employees from six workplaces participating in a two-year cluster randomized controlled trial. The employees were invited by email to participate. At baseline, all participants visited a website to fill out the questionnaire on lifestyle, work, and health factors. Subsequently, a physical health check was offered, followed by face-to-face advice. Throughout the study period, all participants had access to a website with information on lifestyle and health, and to fully automated personalized feedback on the questionnaire results. Only participants in the intervention received monthly email messages to promote website visits during the first year and had access to additional Web-based tools (self-monitors, a food frequency questionnaire assessing saturated fat intake, and the possibility to ask questions) to support behavior change. Website use was monitored by website statistics measuring access. Logistic regression analyses were conducted to identify characteristics of employees who participated in the program and used the website.

Results

Complete baseline data were available for 924 employees (intervention: n=456, reference: n=468). Lifestyle and health factors were not associated with initial participation. Employees aged 30 years and older were more likely to start using the program and to sustain their participation. Workers with a low intention to increase their physical activity level were less likely to participate (Odds Ratio (OR)=0.60, 95% Confidence interval (95%CI), 0.43-0.85) but more likely to sustain participation throughout the study period (ORs ranging from 1.40 to 2.06). Furthermore, it was found that smokers were less likely to sustain their participation in the first and second year (OR=0.54, 95%CI 0.35-0.82) and to visit the website (OR=0.72, 95%CI 0.54-0.96). Website use was highest in the periods immediately after the baseline (73%) and follow-up questionnaires (71% and 87%). Employees in the intervention were more likely to visit the website in the period they received monthly emails (OR=5.88, 95%CI 3.75-9.20) but less likely to visit the website in the subsequent period (OR=0.62, 95%CI 0.45-0.85).

Conclusions

Modest initial participation and high attrition in program use were found. Workers with a low intention to change their behavior were less likely to participate, but once enrolled they were more likely to sustain their participation. Lifestyle and health indicators were not related to initial participation, but those with an unhealthy lifestyle were less likely to sustain. This might influence program effectiveness. Regular email messages prompted website use, but the use of important Web-based tools was modest. There is a need for more appealing techniques to enhance retention and to keep those individuals who need it most attracted to the program.

Trial Registration

ISRCTN52854353; http://www.controlled-trials.com/ISRCTN52854353     

A Web-Based Solution for Viewing Large-Sized Microscopic Images

This paper demonstrates a pure web-based solution enabling the presentation of scanned pathologic microscopic images on the web. For each slide, an entire specimen is scanned, and a high-resolution digital image (in the order of giga-pixels) is reconstructed. These huge images are then tiled into many 256 × 256-pixel blocks with different resolutions, and information about the blocks of each scanned slide is included in an extensible markup language metafile. Based on the data, a virtual microscopy system is created for viewing the scanned pathologic slides on web. The functionalities (changing viewing resolution, location adjustment, and multimedia annotation presentation) of our virtual slide viewing system are accomplished using pure hypertext markup language (HTML) and JavaScript. We show that there is no need to add plug-in components to browsers in order to handle virtual slides on the web. In a heterogeneous healthcare environment, methods using pure HTML and JavaScript to deal with pathologic content are more appropriate than using proprietary technologies supported only by specific browsers.     

Do pain management websites foster self-management support for people with persistent pain? A scoping review

ObjectivesTo evaluate if the contents of pain management websites include the current best practice self-management support strategies for people with persistent pain, are cultural tailored and to determine the website quality.MethodsWebsites were searched from three major search engines (Google, Bing, and Yahoo). Websites providing information on self-management strategies and websites that were freely available to the public were included. The website contents were evaluated using a 14-item self-management support (SMS-14) checklist. Website quality was assessed using the Health On the Net code (HONcode) certification.ResultsOf the twenty-seven websites evaluated, the websites scored a median of nine items (range 1–13) from the SMS-14 checklist. The websites LivePlanBe, ACI Pain Management Network and MyJointPain top-scored (13/14) from the SMS-14 checklist. One website (ACI Pain Management Network) provided culturally tailored information and HONcode certification was present in six websites.ConclusionsThe review identified 27 contemporary pain management websites that could be used for self-management skills training.Practice ImplicationsClinicians could refer people with persistent pain to top ranked websites - LivePlanBe, ACI Pain Management Network, and MyJointPain for enabling self-management skills, with the caveats that most websites lacked cultural tailoring, and have limited or no evidence of clinical efficacy.     

Demographic, behavioral, and psychosocial correlates of using the website component of a worksite physical activity and healthy nutrition promotion program: a longitudinal study

Background

Internet-delivered behavior change programs have the potential to reach a large population. However, low participation levels and high levels of attrition are often observed. The worksite could be a setting suitable for reaching and retaining large numbers of people, but little is known about reach and use of Internet-delivered health promotion programs in the worksite setting.

Objective

This study aimed (1) to gain more insight in the use of the website component of a worksite behavior change intervention and (2) to identify demographic, behavioral, and psychosocial factors associated with website use.

Methods

The study was an observational study among participants from 5 workplaces in a cluster randomized controlled trial. At baseline, all participants visited a study website to fill out the baseline questionnaire. Then a physical health check was done followed by face-to-face advice. After this contact, all participants received an email to promote visiting the website to view their health check results and the personal advice based on the baseline questionnaire. In the subsequent period, only participants in the intervention group received monthly email messages to promote website visits and were offered additional Web-based tools (self-monitors and a food frequency questionnaire [FFQ] assessing saturated fat intake) to support their behavior change. Website use was monitored by website statistics registering website access. Complete data were available for 726 employees. Logistic regression analyses were conducted to identify characteristics of employees who visited and used the website.

Results

In total, 43% of the participants visited the website after the email to promote website visits. Participants who were insufficiently physically active were less likely to visit the website (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.45-0.88), whereas individuals with an elevated total cholesterol level visited the website more often (OR 1.44, 95% CI 1.05-1.98). The monthly emails in the intervention group resulted in higher website use during a 3-month period (18% versus 5% in the reference group, OR 3.96, 95% CI 2.30-6.82). Participants with a positive attitude toward increasing physical activity were less likely to visit the website (OR 0.54, 95% CI 0.31-0.93) or to use the self-monitor and FFQ (OR 0.50, 95% CI 0.25-0.99). Female workers visited the website more often to monitor their behavior and to receive advice on fat intake (OR 2.36, 95% CI 1.14-4.90).

Conclusions

Almost half of the participants used the website component of a worksite behavior change program. Monthly emails were a prompt to visit the website, but website use remained low. More women than men used the website to obtain personalized advice for behavior change. No consistently higher participation was found among those with healthier behaviors. This health promotion program did not provide an indication that healthier subjects are more susceptible to health promotion.

Trial Registration

ISRCTN52854353; http://www.controlled-trials.com/ISRCTN52854353 (Archived by WebCite at http://www.webcitation.org/5smxIncB1)     

北京地区大型医院药剂科网站现状分析

目的分析北京地区大型医院药剂科网站建设情况；方法采用搜索引擎检索，直接访问进行统计；结果北京地区大型医院药剂科普遍建立网站，大部分内容属于介绍药剂科自身，对患者服务很少；结论医院药剂科网站是医院网站的重要组成部分，应定位恰当。同时现在的药利科网站普遍存在着一定的问题，需要药剂科人员端正态度并提高网络应用能力才能够不断完善药剂科网站。     

Supporting Self-Care for Families of Children With Eczema With a Web-Based Intervention Plus Health Care Professional Support: Pilot Randomized Controlled Trial

Background

Childhood eczema, or childhood atopic dermatitis, causes significant distress to children and their families through sleep disturbance and itch. The main cause of treatment failure is nonuse of prescribed treatments.

Objective

The objective of this study was to develop and test a Web-based intervention to support families of children with eczema, and to explore whether support from a health care professional (HCP) is necessary to engage participants with the intervention.

Methods

We followed the PRECEDE-PROCEED model: regular emollient use was the target behavior we were seeking to promote and we identified potential techniques to influence this. LifeGuide software was used to write the intervention website. Carers of children with eczema were invited through primary care mail-out and randomized to 3 groups: (1) website only, (2) website plus HCP support, or (3) usual care. Patient-Oriented Eczema Measure (POEM) scores were measured online by carer report at baseline and at 12 weeks. Qualitative interviews were carried out with 13 HCPs (primarily practice nurses) and 26 participants to explore their experiences of taking part in the study.

Results

A total of 143 carers were recruited through 31 practices. We found a decrease of ≥2 in follow-up compared with baseline POEM score in 23 of 42 (55%) participants in the website only group, 16 of 49 (33%) in the usual care group, and 18 of 47 (38%) in the website plus HCP group. Website use data showed that 75 of 93 (81%) participants allocated to the website groups completed the core modules, but less than half used other key components (videos: 35%; regular text reminders: 39%). There were no consistent differences in website use between the website only or the website plus HCP groups. Qualitative feedback showed that most HCPs had initial concerns about providing support for eczema self-care because this was not a condition that they felt expert in. However, HCPs reported productive consultations and that they found it helpful to use the website in consultations, while observing that some participants seemed to need more support than others. Qualitative interviews with participants suggested that HCP support was valued highly only by a minority, generally those who were less confident in their management of eczema or less confident using the Internet.

Conclusions

Our pilot trial demonstrated the potential for greater improvements in POEM scores in both website intervention groups and that a full-scale trial is feasible. Such a trial would quantify the effectiveness and cost-effectiveness of this intervention to determine whether it should be widely promoted to families of children with newly diagnosed eczema. In this study population, HCP support was not strongly valued by participants and did not lead to better outcomes or website use than use of the Web-based intervention alone.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 98560867; http://www.controlled-trials.com/ISRCTN98560867 (Archived by WebCite at http://www.webcitation.org/6NcxvMtgN).