Website discussion forums: results of an Australian project to promote telecommunication in dermatology

Discussion forums on the Internet allow doctors to discuss issues of interest in a rapid, convenient and educational manner. In March 2002, the department of dermatology at the St George Hospital in Sydney launched a national Website with an online discussion forum for dermatologists. Features of the Website forum include the ability to moderate the discussion boards, a choice of public or private discussions and receipt of automatic email notifications. Over three months, three dermatologists posted a total of 13 messages on three different topics. The low rate of participation by dermatologists may have been due to lack of time or familiarity with the technology. Increased promotion to and education of dermatologists who are most likely to use the discussion forum may improve utilization of this means of communication.     

Dermatology education on the Web

Conventional dermatology teaching favours a didactic, factual approach, rather than a problem-solving approach. A Web-based education system that uses a problem-solving approach offers many advantages. Several international Websites now provide continuing education to specialist dermatologists. These are all 'discretionary' Websites, that is, they are visited by choice; 'obligatory' educational Websites are those tied to a university medical faculty or postgraduate college and which host either online tasks that must be completed or unique examinable material. An interactive education Website, named Dermconsult, has been established unofficially for fellows of the Australasian College of Dermatologists and registrars in training. However, a successful Website will require backing from certifying organizations. Continuing medical education will need to be compulsory for potential users if an educational Website is to be successful.     

Two years' experience with Web-based teleconsulting in dermatology

A non-commercial teledermatology network based on store-and-forward operation was established in April 2002. The aim was to create an easy-to-use platform for teleconsultation services, where physicians could seek diagnostic advice in dermatology from a pool of expert consultants and where they could present and discuss challenging dermatology cases with special emphasis on diagnosis and therapy. An online moderated discussion forum was added in October 2003. During the first two years, 348 health-care professionals from 45 countries registered to use the Website. A total of 783 requests for consultations were answered; 285 requests concerned pigmented skin lesions, 440 requests were from the whole range of clinical dermatology and 58 requests were about non-melanoma skin cancer. Of a total of 133 requests analysed, 80 (60%) were answered within one day, 47 (35%) within one week, five (4%) within two weeks and one (1%) consultation was answered in more than two weeks. Our experience with a discretionary, non-commercial, multilingual Website for open-access teleconsulting in dermatology appears to be successful. The Website represents an example of user-generated content, together with active interaction between users, who can present and discuss cases with remote colleagues.     

Evaluation of an online discussion forum for emergency practitioners

Knowledge is a critical element in the delivery of quality healthcare. In a busy emergency department (ED) clinicians attempting clinically relevant discussion with their peers face multiple interruptions and a lack of sustained meaningful interactions. Information and communication technologies such as online discussion forums enable practitioners to share practice knowledge at times that fit into their daily workflow. We conducted an experiment in which we provided emergency clinicians with access to an asynchronous discussion forum as a medium to support development of an online social network for information exchange. The outcomes were evaluated using a social network perspective to better understand the knowledge seeking and sharing behaviors among rural and urban emergency practitioners participating in the online discussion forum. The online discussion forum created an opportunity for emergency practitioners from multiple ED sites to engage in dialogue around topics that were relevant to their practice learning needs.     

Is It Safe to Vape? Analyzing Online Forums Discussing E-Cigarette Use during Pregnancy

IntroductionElectronic cigarette (e-cigarette) use, or vaping, is increasing against a backdrop of declining smoking rates. E-cigarettes contain fewer toxicants than cigarettes, but their appearance and mode of use has the potential to satisfy the habitual aspects of smoking. To date, we know little about lay perceptions of the safety of using e-cigarettes in pregnancy.MethodsWe conducted a thematic discourse analysis of 13 online discussion forum threads that discussed e-cigarette use during pregnancy. We focused on the major discursive strategies that forum posters used to debate the safety of e-cigarette use during pregnancy.ResultsWe identified three distinct ways in which forum posters debated the safety of using e-cigarettes during pregnancy: 1) quitting (nicotine) cold turkey is unsafe, 2) vaping is the lesser of two evils, and 3) vaping is not worth the risk.ConclusionsDiscussions about the safety of e-cigarettes drew on the premise that 1) immediate cessation of nicotine was potentially harmful and unsafe, 2) e-cigarettes were a harm reduction tool, or 3) vaping could be dangerous and should be avoided. Although these arguments are not necessarily specific to pregnancy (beside mentions of fetal-specific risks), this analysis points to the need to educate and support women about harm reduction options.ImplicationsHealth professionals should be aware that some women may be currently using or considering using e-cigarettes in an effort to quit or reduce smoking. It is important that health professionals are equipped to educate women with accurate, up-to-date, and balanced information about the risks and benefits of e-cigarette use during pregnancy.     

The clinical television record

At the symposium the session on clinical television took the form of an open forum — as can be imagined with such a wide topic the debate left many questions unanswered and some unasked. Rather than attempt to recreate an open-ended discussion, this article outlines some of the salient points and the ways that clinical television may develop in the future.     

Preliminary guidelines for the implementation of Community Based Rehabilitation (CBR) approaches in rural, remote and Indigenous communities in Australia

A forum of health professionals was held in Brisbane, Queensland, Australia, 30-31 August 2003, to discuss the relevance and potential of the Community Based Rehabilitation (CBR) model to rural, remote and Indigenous communities in Australia. The forum identified principles and guidelines for the development of CBR, which are presented here as a focus point for future discussion and action by people with disabilities, rural community members, Indigenous people, policy makers and health professionals. Forum members noted that while considerable strengths were evident in the CBR model, it has yet to make a significant impact on the service system in Australia. While recognising that the Australian context is quite different from many countries in which CBR has traditionally been implemented, they suggested that it may have particular application to remote, rural and Indigenous communities. To facilitate the principles of CBR in these communities, the forum called for recognition of the need for greater community involvement in disability services, the need to develop appropriate training frameworks, and the need to redirect resources to such community models. In keeping with the CBR philosophy, forum members noted that if the model is to be implemented effectively, substantial consumer and community involvement will be instrumental in future steps.     

'Oh dear, should I really be saying that on here?': issues of identity and authority in an online diabetes community

We explore peer-to-peer discussions which took place in a UK-based diabetes 'Virtual Clinic' online community. In particular, we seek to understand the rhetorical nature and content of exchanges over a period of six months from the community's inception. Data were captured weekly and analysis based on thematic discourse analysis. Two key issues emerged regarding how the community shaped the nature of the discussion forum. First, the identity of the forum was established, and boundaries drawn about what was, and was not, acceptable. Second, participants sought to present themselves as reliable and authoritative sources of information. Internet discussion communities are shaped in important ways early on by the community of users, including how the character and focus of discussion is formed, and how both information and users can be constructed as authoritative and reliable.     

Biopedagogy digitalized: ‘educational’ relations among participants on an online weight loss surgery forum

Foucault uses the term ‘biopower’ to describe the totalizing effects of regulation of life through the manipulation of political messages, such as those in the obesity debate. This paper attempts to uncover ways in which these flows are made manifest among members of a public online weight loss surgery (WLS) discussion forum. Drawing from Foucauldian scholarship, we spent two-and-a-half years conducting a critical discourse analysis of over 2000 conversational threads on one US-based public discussion forum devoted to providing a support community to those who were considering WLS. Our intent is to analyze how ‘truths’ about the surgery are constructed among and between the community participants at different stages of the surgery to identify how they engage with ideologies associated with contemporary obesity and healthism.     

The 'expert patient': empowerment or medical dominance? The case of weight loss, pharmaceutical drugs and the Internet

Do 'informed' or 'expert' patients challenge dominant traditions in biomedicine or simply adopt these as conventional ways of thinking about body shape and size, illness and health? This paper examines this question in relation to the use of the weight-loss drug Xenical by participants in an Internet forum for obese and overweight people. Ethnographic and interview data from the forum provides evidence that participants share information and support each other as they use Xenical, and in the process emerge as 'expert patients' in relation to their body shape and its treatment. However, it is argued that while an 'expert patient' can be perceived as desirable, enabling the democratisation of healthcare, it can also be constraining. The exchanges between the users in the forum perpetuate a biomedical model of overweight as a condition to be overcome. The discussion critically considers a number of options for the development of the expert patient, including the emergence of an 'informed consumer'.     

Development of a website for clinical microbiology in Brazil

The quality of Brazilian health services, including clinical microbiology laboratories, varies enormously. We established a Website to provide different professionals with up-to-date information and to create a virtual Brazilian microbiology community. The Website became operational in February 2000 and had 198,976 hits in the subsequent 20 months. There were 1031 user registrations in its virtual community. Different microbiology topics were discussed and three virtual training courses (representing about 300 printed pages of information) were given. The e-learning centre and the Brazilian virtual community created by this Website have facilitated distance learning, and have encouraged professional integration within Brazilian clinical microbiology.     

What Do You Say Before You Relapse? How Language Use in a Peer-to-peer Online Discussion Forum Predicts Risky Drinking among Those in Recovery

Increasingly, individuals with alcohol use disorder (AUD) seek and provide support for relapse prevention in text-based online environments such as discussion forums. This paper investigates whether language use within a peer-to-peer discussion forum can predict future relapse among individuals treated for AUD. A total of 104 AUD sufferers who had completed residential treatment participated in a mobile phone-based relapse-prevention program, where they communicated via an online forum over the course of a year. We extracted patterns of language use on the forum within the first four months on study using Linguistic Inquiry and Word Count (LIWC), a dictionary-based text analysis program. Participants reported their incidence of risky drinking via a survey at 4, 8, and 12 months. A logistic regression model was built to predict the likelihood that individuals would engage in risky drinking within a year based on their language use, while controlling for baseline characteristics and rates of utilizing the mobile system. Results show that all baseline characteristics and system use factors explained just 13% of the variance in relapse, whereas a small number of linguistic cues, including swearing and cognitive mechanism words, accounted for an additional 32% of the total 45% of variance in relapse explained by the model. Effective models for predicting relapse are needed. Messages exchanged on AUD forums could provide an unobtrusive and cost-effective window into the future health outcomes of AUD sufferers, and their psychological underpinnings. As online communication expands, models that leverage user-submitted text toward predicting relapse will be increasingly scalable and actionable.     

A Web-based intervention used in general practice for people with excessive alcohol consumption

Down Your Drink is a Web-based brief intervention for hazardous drinkers. We conducted a pilot study of its usefulness in general practice. Visitors to the Website were invited to complete the Fast Alcohol Screening Test and positive responders were offered a six-week interactive Web-based programme. There were 1319 registrations in the six-month study period. In all, 815 (62%) registrants completed week one, and 79 (6%) stayed with the programme until the end. Usage of the Website was distributed through the day, with the highest levels between 10:00 and 14:00. Two focus groups with general practitioners were conducted to explore the potential for using the site in primary-care settings. Website interventions for excessive drinkers therefore appear to be feasible and may prove a useful additional tool for intervention in general practice.     

Health information Websites: characteristics of US users by race and ethnicity

We conducted a national public opinion survey of adults aged 18 years or older in the continental US to determine their use of health Websites. Of the 928 individuals contacted, 868 (94%) reported their race/ethnicity. More non-Hispanic Whites reported using the Internet (34%) than African Americans (31%) and Hispanics (20%). We used logistic regression to estimate adjusted odds ratios describing the relationship between Website usage and covariates across the racial/ethnic subgroups. Whereas better perceived health was associated with greater Website use among Hispanics and Whites, stronger health literacy was associated with greater use among Hispanics. No African American or Hispanic respondent aged 65 years or older reported going online. The relationship between education and use was more than twice as strong for African Americans and Hispanics than other groups. That some minority groups are less likely to use the World Wide Web for health information may further compound existing disparities. One place where this problem may be addressed is in the nation's schools.     

Teledermatology as a tool for communication between general practitioners and dermatologists

A feasibility study of teledermatology was undertaken in Groningen. Six general practitioners (GPs) sent digital images by email, along with relevant patient information, to dermatologists at the Martini Ziekenhuis Groningen, a general non-academic hospital. The dermatologists returned their responses by email. A total of 89 cases were dealt with in this way. On average, the GPs took three photographs per patient. The time taken by the GP to produce and transmit the images, and to implement the telemedicine advice received from the dermatologist, was 9 min and 3 min, respectively. The time spent on diagnosis, provision of advice and response by email amounted to 10 min for the dermatologist. It was concluded that teleconsultations by email are feasible in the daily practice of GPs and dermatologists in a general non-academic hospital. Generally, GPs, dermatologists and patients were satisfied with teleconsultations. Furthermore, GPs reported that 63% of the teleconsultations were of educational value.     

Electronic discussion forums in medical ethics education: the impact of didactic guidelines and netiquette

OBJECTIVES: The quality of computer-mediated asynchronous group discussion in educational settings often has potential for improvement. To this end, 2 categories of recommendations can be found in the literature. Some authors advise providing didactic guidelines to students. Others recommend informing students about the basics of (formal) network etiquette (netiquette). This paper investigates whether the type of guideline provided has an effect on either or both the quality of asynchronous group discussion and the appraisal of participants in the context of a course in medical ethics. METHODS: A total of 112 students graduating in the biomedical sciences were randomly assigned to electronic discussion groups of 18-19 participants each. Three treatment groups were created by varying the guidelines presented to participants upon entering the discussion forum. Guidelines contained trivial information, netiquette advice, or a combination of didactic guidelines and netiquette advice. RESULTS: Both the quality of discussion and the participants' appraisal of the discussion were highest in the third group. However, contrary to what is widely suggested, it was observed that exclusively supplying netiquette guidelines had no impact on discussion quality. CONCLUSIONS: To improve the quality of asynchronous group discussion, it is advisable to provide not only netiquette rules, but also didactic guidelines. Future research should focus on the effects of netiquette guidelines on students of different levels and skills and should allow for disentangling the effects of netiquette and didactic guidelines. It might also seek to establish methods of disseminating guidelines that enhance their effect.     

秉承初心，践行使命——2022年复旦大学博士生学术论坛之“公共卫生”篇

2022年12月10日，由复旦大学研究生院、复旦大学党委研究生工作部、复旦大学公共卫生学院主办的2022年复旦大学博士生学术论坛之“公共卫生”篇在复旦大学公共卫生学院顺利召开。本次论坛累计收到来自全国各高校和科研单位的稿件53篇，其中10篇被遴选为优秀论文并进行论坛汇报。论坛当天100余名师生出席，围绕“秉承科研报国初心，践行公卫青年使命”的主题，完成了上午的科研成果汇报和下午的圆桌会议2项内容。与会专家和同学们就突发公共卫生事件的防控与管理等话题进行了深入探讨和交流，对同学们开拓视野，秉承初心，践行使命，进一步深入公共卫生研究大有裨益。