World Wide Web and Internet: applications for radiologists

Global exchange of information is one of the major sources of scientific progress in medicine. For management of the rapidly growing body of medical information, computers and their applications have become an indispensable scientific tool. Approximately 36 million computer users are part of a worldwide network called the Internet or “information highway” and have created a new infrastructure to promote rapid and efficient access to medical, and thus also to radiological, information. With the establishment of the World Wide Web (WWW) by a consortium of computer users who used a standardized, nonproprietary syntax termed HyperText Markup Language (HTML) for composing documents, it has become possible to provide interactive multimedia presentations to a wide audience. The extensive use of images in radiology makes education, worldwide consultation (review) and scientific presentation via the Internet a major beneficiary of this technical development. This is possible, since both information (text) as well as medical images can be transported via the Internet. Presently, the Internet offers an extensive database for radiologists. Since many radiologists and physicians have to be considered “Internet novices” and, hence, cannot yet avail themselves of the broad spectrum of the Internet, the aim of this article is to present a general introduction to the WWW/Internet and its applications for radiologists. All Internet sites mentioned in this article can be found at the following Internet address: http://www.univie.ac.at/radio/radio.html (Department of Radiology, University of Vienna) Received: 2 February 1998; Revision received: 11 June 1998; Accepted: 27 July 1998     

Effective use of medical-scientific Internet resources

Hintergrund: Das Medium Internet ist nicht hierarchisch strukturiert und unterscheidet sich daher von herk?mmlichen Wissensquellen. Die ansteigende Zahl medizinisch-wissenschaftlicher Webseiten bietet dem Augenarzt umfangreiche, jedoch nicht immer leicht zu erschlie?ende Informations- und Weiterbildungsm?glichkeiten. Material und Methode: Die Effektivit?t einer Internet-Recherche h?ngt vom Wissenstand über vorhandene Suchstrategien ab. Es werden Suchsysteme (Search engines, Kataloge, Datenbanken, Indizes) dargestellt sowie Hinweise für deren effektive Nutzung (Metasearch, Anwendung von Boolean-Operatoren, Wortgruppen-Suche) gegeben. Die Effizienz der Suche wird anhand konkreter Ergebnisse, deren Aktualit?t und der Anwenderfreundlichkeit der verwendeten Systeme bewertet. Neue, zukunftsweisende Applikationen wie SemioMap und Intelligent Agents werden vorgestellt. Ergebnisse und Schlu?folgerung: Bei Anwendung effektiver Suchstrategien stellt das Internet bereits heutzutage eine einfache und schnell zu nutzende Informationsquelle für den Arzt und Wissenschaftler dar. Die verfügbaren medizinisch-wissenschaftlichen Ressourcen leisten zunehmend aktuelle und praxisbezogene Beitr?ge zu fachspezifischer Weiterbildung und zukunftsorientierter Forschung.      

Digital psychiatry

The American managed care movement has been viewed as a big experiment and is being watched closely by the rest of the world. In the meanwhile, computer-based information technology (IT) is changing the practice of medicine, much more rapidly than managed care. A New World of digitized knowledge and information has been created. Although literature on IT in psychiatry is largely absent in peer-reviewed psychiatric journals, IT is finding its way into all aspects of medicine, particularly psychiatry. Telepsychiatry programs are becoming very popular. At the same time, medical information sites are flourishing and evolving into a new health-care industry. Patient-physician information asymmetry is decreasing as patients are gaining easy access to medical information hitherto only available to professionals. Thus, psychiatry is facing another paradigm shift, at a time when most attention has been focused on managed care. In this new digital world, knowledge and information are no longer the sole property of professionals. Value will migrate from traditional in-person office-based therapy to digital clinical products, from in-person library search and classroom didactic instruction to interactive on-line searches and distance learning. In this time of value migration, psychiatrists have to determine what their 'distinctive competence' is and where best to add value in the health-care delivery value chain. The authors assess the impact of IT on clinical psychiatry and review how clinical practice, education and research in psychiatry are expected to change in this emerging digital world.     

Online-Kurs Notfallmedizin Kurrikulare Integration von Computer-based Training

Emergency medicine is characterized by rapid decision making to help patients in life-threatening situations. Teaching these skills requires a high level of interaction between medical students and the lecturer. We designed, implemented, and evaluated a generic computer-based training (CBT) system to provide a more active way of learning emergency medicine. The content of the training program is adapted to the knowledge of third year medical students and is focused on basic skills and real-world problems. The teacher presents the case with authentic video sequences and slides. The cases are classified into four groups: heart (e.g., myocardial infarction), respiration (e.g., asthma bronchiale), trauma (e.g., car accident), and loss of consciousness (e.g., coma). Within a realistic time frame, the students have to answer free text and multiple choice questions on a work-station. All answers given by the students are processed anonymously by the CBT system via a central server and displayed on a large video screen, thus enabling a detailed discussion without intimidation of individual students. This interactive technique allows for immediate feedback from the lecturer based on the specific knowledge of his group and his own experience. The IT concept, which is scalable to many subjects, is based on state of the art internet technology and therefore suitable for teleteaching. A major design objective for the program was a self-explaining and robust user interface. The system has been in routine use since 1998. We designed an evaluation form consisting of 21 items focused on subjective rating of learning success, acceptance of CBT, and technical feasibility. We analyzed forms from 138 students and found high scores for acceptance and learning success (median 5 on a 6-point scale). user problems with the program were denied (median 1 on a 6-point scale). Computer-based training with Internet technology can provide a successful method for interactive teaching of emergency medicine and is well accepted by students.     

新型卫生投入政策研究

本文提出了一整套新型卫生投入政策方案，总目标是建立起“四级两块式”卫生投入政策，具体目标模式有：改革卫生投入方式，实行“五级浮动式”医疗价格体制，建立医疗价格政策性补贴，增加公共卫生投入，整合卫生资源。并进行可行性论证。     

用Internet技术构建新型农村合作医疗网络

本文针对海南省新型农村合作医疗结算网络系统建设的实际情况，提出了一套依托于覆盖全省的现有互联网络，采用浏览器／服务器(B／S)体系结构，构建海南省新型农村合作医疗结算网络的技术方案，重点讨论了网络的拓扑结构和方案的设计要点，并对实现的技术方案进行了综合评价，以作为对我国建立新型农村合作医疗信息系统的一点初步探讨。     

韩国医疗服务支付方式改革对我国的启示

随着我国城镇职工基本医疗保险制度改革的深入，支付方式的改革越来越显得重要。我国与韩国一样，在社会医疗保险初期，支付方式都是按服务项目付费、这种支付方式导致服务数量的增加、治疗方案的扭曲，医生更愿意提供收益好的服务。为了寻求解决办法，韩国在1997年尝试实施按诊断相关分组(DRG)的支付方式。通过对韩国支付方式改革的回顾，为我国城镇职工基本医疗保险支付方式的改革提供借鉴。     

现金卫生支出贫困影响的分析方法研究

现金卫生支出的贫困影响方法研究是卫生领域公平性系列研究的重要组成部分。在借鉴国际研究成果的基础上，结合我国实际情况对其分析方法进行探索性研究，旨在从卫生筹资公平性角度，详细阐述现金卫生支出对贫困影响研究的分析方法和政策意义。     

四种治疗难治性肺结核方案的费用-效果分析

目的探讨不同的药物治疗方案对难治性肺结核的费用-效果。方法运用费用-效果分析法对A、B、C、D4种治疗难治性肺结核的方案进行分析评价。结果每种方案结核菌阴转率的费用-效果比(元/%)分别为,A:30.94,B:24.42,C:25.40,D:35.90;X片好转率的费用-效果比(元/%)分别为,A:25.61,B:21.70,C:23.34,D:30.37。结论B组为较佳治疗方案,值得推广应用。     

WHO 网站与药物流行病学

目的：介绍世界卫生组织网站中的药物流行病学信息。方法：介绍世界卫生组织网站结构和药物流行病学信息所处栏目。结果：药物流行病学信息主要分布于健康主题和WHO子网站中。结论：世界卫生组织网站中有丰富的药物流行病学信息。