Search

Objectives: Health-related websites are an important source of information for the public. Increasing public awareness of overdiagnosis and ductal carcinoma in situ (DCIS) in breast cancer screening may facilitate more informed decision-making. This study assessed the extent to which such information was included on prominent health websites oriented towards the general public, and evaluated how it was explained. Design: Cross-sectional study. Setting: Websites identified through Google searches in England (United Kingdom) and New South Wales (Australia) for “breast cancer screening” and further websites included based on our prior knowledge of relevant organisations. Main Outcomes: Content analysis was used to determine whether information on overdiagnosis or DCIS existed on each site, how the concepts were described, and what statistics were used to quantify overdiagnosis. Results: After exclusions, ten UK websites and eight Australian websites were considered relevant and evaluated. They originated from charities, health service providers, government agencies, and an independent health organisation. Most contained some information on overdiagnosis (and/or DCIS). Descriptive information was similar across websites. Among UK websites, statistical information was often based on estimates from the Independent UK Panel on Breast Cancer Screening; the most commonly provided statistic was the ratio of breast cancer deaths prevented to overdiagnosed cases (1:3). A range of other statistics was included, such as the yearly number of overdiagnosed cases and the proportion of women screened who would be overdiagnosed. Information on DCIS and statistical information was less common on the Australian websites. Conclusions: Online information about overdiagnosis has become more widely available in 2015–16 compared with the limited accessibility indicated by older research. However, there may be scope to offer more information on DCIS and overdiagnosis statistics on Australian websites. Moreover, the variability in how estimates are presented across UK websites may be confusing for the general public. [ABSTRACT FROM AUTHOR]

One of the major concerns of research in integrated healthcare information systems is to enable decision support among clinicians across boundaries of organizations and regional workgroups. A necessary precursor, however, is to facilitate the construction of appropriate awareness of local clinical practices, including a clinician's actual cognitive capabilities, peculiar workplace circumstances, and specific patient-centered needs based on real-world clinical contexts across work settings. In this paper, a user-centered study aimed to investigate clinical practices across three different geographical areas—the U.K., the UAE and Nigeria—is presented. The findings indicate that differences in clinical practices among clinicians are associated with differences in local work contexts across work settings, but are moderated by adherence to best practice guidelines and the need for patient-centered care. The study further reveals that an awareness especially of the ontological, stereotypical, and situated practices plays a crucial role in adapting knowledge for cross-boundary decision support. The paper then outlines a set of design guidelines for the development of enterprise information systems for e-health. Based on the guidelines, the paper proposes the conceptual design of CaDHealth, a practice-centered framework for making sense of clinical practices across work settings for effective cross-boundary e-health decision support. [ABSTRACT FROM PUBLISHER]

Background:Reliable information can improve patients' knowledge of chemotherapy. As internet chemotherapy information (ICI) is increasingly viewed as a valuable patient education tool, we investigated the impact of ICI on patient care and analysed health professionals' (HPs') attitudes towards ICI.Methods:The following questionnaires were distributed: (1) self-administered questionnaire randomly given to 261 patients receiving chemotherapy (80% returned); and (2) separate questionnaire given to 58 HPs at the same UK Oncology Centre (83% returned).Results:Just over half of the patient respondents accessed the internet regularly. They were younger, with higher incomes and qualifications. Key search topics included chemotherapy modes of action, symptom management and treatment success, and most considered ICI useful. More than half wanted to discuss ICI with HPs but most did not get the opportunity. Although the majority of HP respondents supported the need for patients to retrieve ICI, most questioned the accuracy of ICI and did not routinely recommend its use.Conclusion:This study has shown that ICI is generally perceived by patients to be a valuable information resource. Given the potential impact of ICI, the following should be addressed in future studies: (1) inequalities in accessing ICI; (2) maintaining the quality of ICI (with clear guidance on recommended websites); (3) bridging the gap between the perception of ICI by patients and HPs; (4) integration of ICI with traditional consultation models. [ABSTRACT FROM AUTHOR]

Background: Access to medical records on the Internet has been reported to be acceptable and popular with patients, although most published evaluations have been of primary care or office-based practice. We tested the feasibility and acceptability of making unscreened results and data from a complex chronic disease pathway (renal medicine) available to patients over the Internet in a project involving more than half of renal units in the UK. Methods: Content and presentation of the Renal PatientView (RPV) system was developed with patient groups. It was designed to receive information from multiple local information systems and to require minimal extra work in units. After piloting in 4 centres in 2005 it was made available more widely. Opinions were sought from both patients who enrolled and from those who did not in a paper survey, and from staff in an electronic survey. Anonymous data on enrollments and usage were extracted from the webserver. Results: By mid 2011 over 17,000 patients from 47 of the 75 renal units in the UK had registered. Users had a wide age range (<10 to >90 yrs) but were younger and had more years of education than non-users. They were enthusiastic about the concept, found it easy to use, and 80% felt it gave them a better understanding of their disease. The most common reason for not enrolling was being unaware of the system. A minority of patients had security concerns, and these were reduced after enrolling. Staff responses were also strongly positive. They reported that it aided patient concordance and disease management, and increased the quality of consultations with a neutral effect on consultation length. Neither patient nor staff responses suggested that RPV led to an overall increase in patient anxiety or to an increased burden on renal units beyond the time required to enrol each patient. Conclusions: Patient Internet access to secondary care records concerning a complex chronic disease is feasible and popular, providing an increased sense of empowerment and understanding, with no serious identified negative consequences. Security concerns were present but rarely prevented participation. These are powerful reasons to make this type of access more widely available. [ABSTRACT FROM AUTHOR]

In this article we explore how the experience of searching for Online Health Information (OHI) becomes a meaningful activity in the lives of older adults living with chronic health conditions. A descriptive phenomenological approach was adopted to contribute to the overall understanding of individuals' lived experiences of OHI-seeking through an exploration of the consciousness of the experiencer. This article provides rich experiential descriptions that have the potential to make a contribution toward healthcare practice within the UK by providing healthcare professionals with an understanding of patient experience that can help them identify patients' needs and make improvements to care in terms of the quality of empathy and understanding for older adults with chronic health conditions. The findings also provide rich stories of older adults actively engaging in this form of health information seeking, data that could be used to challenge pre-conceptions that age is a barrier to using the Internet for this purpose. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Internet based Cognitive Behavioural Therapy (iCBT) represents a significant development in the way psychological interventions are delivered. Studies tend to recruit via common media channels leading to criticisms of biased sample sizes and limited generalisability to primary care settings. Aim: To evaluate the use of a prevalence recruitment strategy within primary care to recruit into an RCT examining a free to use iCBT intervention. Methods: Fully randomised controlled trial (RCT), utilising a prevalence based recruitment strategy, comparing the iCBT intervention with telephone support provided by NHS Direct Health Advisors with treatment-as-usual (TAU) control. Results: Recruitment rates were low with only 7 participants recruited over 8months. Overall only 14% of expected study invitations were sent, with only 1% undertaking the consent and initial screening process. Discussion: Key differences with successful prevalence recruitment strategies highlight four main issues to consider when recruiting participants from primary care into iCBT studies — lack of equipoise, a need for an assertive approach, coding of depression in GP databases and help seeking behaviour in depression which can all act as potential contributors to failure to recruit. However other non-primary care recruitment methods, such as the use of media channels, which are already shown to be effective in non-primary care settings should be considered if these methods more accurately target the population who would be willing to adopt iCBT more generally. [Copyright &y& Elsevier]

Abstract: ‘Legal highs’ are compounds, plant or fungal material which can be readily bought from the internet without legal restriction and the single chemicals may be structurally related to illegal drugs of abuse such as the amphetamines. Several recent deaths in the UK have been attributed to these legal highs and unfortunately there is little chemical or biological literature on these materials or certified standards. Here, we detail the analysis of the widely consumed synthetic N-methyl-cathinone analogue known as mephedrone ((1) 2-aminomethyl-1-tolyl-propan-1-one (4′-methylmethcathinone)) and report its spectral data and molecular properties. Material was purchased from an internet site and examined by extensive one- and two-dimensional NMR studies, high-resolution mass spectrometry, elemental analysis and optical rotation, which demonstrated the sample to be of high purity and racemic in nature. Additionally, we report the molecular modelling properties of methyl-cathinones and compare them to their corresponding methyl-amphetamine series. This indicated that the methyl-cathinones are considerably more hydrophilic than the methyl-amphetamines which may account for the higher doses that are needed to demonstrate similar effects. The presence of a ketone in the side chain introduces a far more planar quality to the methyl-cathinones which is absent in the methyl-amphetamine series, and this planarity may contribute to toxicity. [Copyright &y& Elsevier]

We established a medical education website to deliver real-time, clinical case-based education to sites in Somaliland from the UK. The website was based on a web 2.0 social networking concept in order to recreate, as nearly as possible, the clinical bedside teaching experience. A survey showed that medical students in Somaliland had sufficient computer access to exploit the website. Teaching began in December 2008 and the teaching programme has developed into a regular weekly teaching session involving up to seven different student groups in Somaliland at different locations. As well as north-south teaching, the website has been employed to support a study module in London. Small groups of UK-based medical students have been partnered with intern tutors in Somaliland. Forty UK students have taken part in this teaching, which is now in its second year. Feedback from those involved has demonstrated that a collaboration in which both north-south and south-north teaching occurs can strengthen partnerships in which both parties contribute and benefit. [ABSTRACT FROM AUTHOR]

Medical Education 2010: 44 : 316–322 Objectives Good Medical Practice, produced by the General Medical Council (GMC), represents the professional code of practice for doctors in the UK. It is regularly updated to reflect the changing relationships of the profession with both patients and society in general. The discourse within this guidance appears to have shifted over time to a stance that aligns itself more closely with the protection of patients, rather than with the traditional professional provision of guidance and support to doctors. Methods Tag clouds are a feature of the latest applications of the World Wide Web, commonly known as Web 2.0. They can be used to rapidly analyse textual data, revealing textual messages in a pictorial form. Tag cloud-generating software was used to produce tag clouds of four texts illustrating GMC guidance produced between 1963 and 2006 to aid textual analysis and to determine whether this methodology could pick up this change in tenor. Results This analysis supports the view that there has been a shift from a doctor-centred regulatory discourse to a patient-centred health improvement agenda over the period of time examined. Discussion Whether this documentation voices a deprofessionalisation agenda or simply mirrors a period of societal change in general is discussed. The changing discourse around professionalism highlights the need to avoid adopting ‘nostalgic’ notions of professionalism in educating doctors and reinforces where the GMC sees we should focus our education efforts: in patient-centred care and team-working. The demands on, and responsibilities of students and juniors entering the profession have been fundamentally altered and our teaching, particularly in the domain of professionalism, needs to reflect this. Tag clouds provide an interesting and innovative way of analysing text and revealing obscured discourses, and their potential in education and research is worthy of further exploration. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: (1) To assess expectations and experiences of a new eHealth service by patients and staff in three primary care settings; (2) to ascertain attitudes to a range of future, primary care-oriented eHealth services. Design: Qualitative case study. Setting: Three UK general practices introducing an eHealth service for booking patient appointments. Participants: Ninety patients purposively selected from users and non-users of the new service and 28 staff (clinicians, management and administrative staff). Results: Actual patient use of the service was lower than stated intention. Patients and staff felt that more active promotion of the service would have resulted in more use. Low usage did not result in a negative assessment of the service by most staff. Different patient groupings were identified with characteristics that may be used as predictors of eHealth service use and indicators of training needs. GPs and patients expressed opposing viewpoints on a range of future eHealth services. Conclusions: Take-up of eHealth services may be lower than expected. To overcome patient barriers, factors that may narrow the intention–behaviour gap such as level of service promotion, GP endorsement, and usage by different patient groups, should be investigated. For clinician barriers, the eHealth evidence base needs strengthening, while for primary care practices, a learning process including staff training needs to be instituted. The differing views of patients and GPs about components of eHealth means that policymakers need to plan for a lengthy political process to obtain agreement on contentious issues if they are to achieve successful eHealth services. [Copyright &y& Elsevier]

Abstract: Background: The evidence base for the treatment of adolescents with bulimia nervosa (BN) is limited. Aims: To assess the feasibility, acceptability, and clinical outcomes of a web-based cognitive-behavioural (CBT) intervention for adolescents with bulimic symptomatology. Method: 101 participants were recruited from eating disorders clinics or from beat, a UK-wide eating disorders charity. The programme consisted of online CBT sessions (‘Overcoming Bulimia Online’), peer support via message boards, and email support from a clinician. Participants'' bulimic symptomatology and service utilisation were assessed by interview at baseline and at three and six months. Participants'' views of the treatment package were also determined. Results: There were significant improvements in eating disorder symptoms and service contacts from baseline to three months, which were maintained at six months. Participants'' views of the intervention were positive. Conclusions: The intervention has the potential for use as a first step in the treatment of adolescents with bulimic symptomatology. [Copyright &y& Elsevier]

Objectives: A new modular teaching programme, housed within a virtual learning environment (VLE) was introduced in Bristol in 2004 to complement the academic training of orthodontic postgraduates. The aims of this study were to evaluate whether its introduction had reduced travel commitments for trainees, reduced demands on academic staff and whether it had any effect on teaching and learning. Design: An investigative mixed methods study designed to collect and analyse verbal and written data. Setting: The South West Region of the UK subjects and methods: semi-structured interviews and focus groups with nine trainees and 14 trainers were taped and transcribed. Written data were coded and analysed thematically. The qualitative data from interviews and focus groups were complemented with written data from trainee diaries and a limited amount of quantitative data collected from the VLE. Conclusions: Travel commitments for trainees have reduced as a result of introducing the web-based resource, but not as expected. Demands on academic staff have not reduced but have changed. The resource has had positive effects on postgraduate orthodontic teaching and learning. Important themes of interest emerging from the data are improvements in the flexibility and efficiency of learning and the value of the resource as a repository of information and in the organization of teaching and learning. Despite the popularity of this web based learning resource, trainees continue to value the opportunity to interact face to face with their teachers and peers and are prepared to travel for organized teaching sessions. [ABSTRACT FROM AUTHOR]

The aim of this study was to synthesize qualitative data on men's experiences of coronary heart disease (CHD). The authors searched for qualitative papers published before January 2007 in MEDLINE, EMBASE, British Nursing Index, CINAHL, PsychINFO and Web of Knowledge and used thematic analysis to synthesize findings. They found 136 studies that collected data on men's experiences of CHD. Only 27 studies took a gendered approach and only two aimed to investigate men's gendered experiences of CHD. Many men drew on discourses associated with hegemonic masculinity (e.g. demonstrating stoicism through delaying seeking professional help) when talking about the implications of the disease for their identity, relationships and paid work. However, some accounts challenged this dominant discourse. The authors argue that a more nuanced understanding of hegemonic masculinity should take account of the production of gendered narratives in the interview context, given that men 'do' gender when they give the impression of 'not doing' health. [ABSTRACT FROM AUTHOR]

Objectives: To compare the characteristics of a self-selected, convenience sample of men who have sex with men (MSM) recruited through the internet with MSM drawn from a national probability survey in Great Britain. Methods: The internet sample (n = 2065) was recruited through two popular websites for homosexual men in Great Britain in May and June 2003. This sample was compared with MSM (n = 117) from the National Survey of Sexual Attitudes and Lifestyles (Natsal), a probability sample survey of adults resident in Great Britain conducted between May 1999 and February 2001. Results: No significant differences were observed between the samples on a range of sociodemographic and behavioural variables (p>0.05). However, men from the internet sample were younger (p<0.001) and more likely to be students (p = 0.001), but less likely to live in London (p = 0.001) or report good health (p = 0.014). Although both samples were equally likely to report testing for HIV, men from the internet sample were more likely to report a sexually transmitted infection in the past year (16.9% v 4.8%, adjusted odds ratio 4.14, 95% CI 1.76 to 9.74; p = 0.001), anal intercourse (76.9% v 63.3%; p = 0.001) and unprotected anal intercourse in the past 3 months (45% v 36.6%; p = 0.064). Conclusions: The internet provides a means of recruiting a self-selected, convenience sample of MSM whose social and demographic characteristics are broadly similar to those of MSM drawn from a national probability survey. However, estimates of high-risk sexual behaviour based on internet convenience samples are likely to overestimate levels of sexual risk behaviour in the wider MSM population. [ABSTRACT FROM AUTHOR]

Keypoints • Audiovisual teaching material can now be watched using a personal computer or portable media device. • The cost of delivering video across the Internet has fallen considerably in recent years. • Podcasting technology automates the distribution of audio and video across the Internet. • Podcasting technology, with the Internet, has the potential to improve learning. • To access podcasts all you need is a computer, free software and an Internet connection. [ABSTRACT FROM AUTHOR]

Keypoints • An internet-based audit was conducted to determine how well English otolaryngology departments apply Action on ENT baseline clinical and administrative standards. • A total of 91% (97 of 107) departments responded. • Only 8% of 97 departments met all 23 standards but the majority complied with most standards. • Microsuction and outpatient endoscopy were almost universally available (99% and 97% respectively) and 98% monitored in-patient and day surgery activity. • Compliance was poor (<60%) for three standards: common waiting lists for common conditions (51%), facilities to elicit patient feedback (56%) and the inclusion of a treatment plan in the notes (46%). More than one in four departments lacked dedicated facilities to treat children or a lead clinician for paediatric audiology, despite the Children Acts of 1989 and 2004. • It is hoped that this audit will help sub-optimal units to correct their deficiencies. [ABSTRACT FROM AUTHOR]

The article assesses how the Internet at present is being used by patients and clinicians in Great Britain, and assess the emerging patterns. The review was based on materials obtained from Medline search under the terms National Health Service, Internet, outcomes, patient, information and United Kingdom. The author has concluded that patient and clinicians use the Internet in inconsistent and sub-optimal ways, but the lack of outcome-based studies hampers identification of ideal strategies.

The Government in Britain is set on using the Internet to expand the provision of health information to the general public. Concerns over the quality of the health information have preoccupied commentators and organizations rather than the way users interact with health information systems. This report examines the issues surrounding the provision of electronic health information, and describes an evaluation undertaken of a commercial health website—that of Surgerydoor (http://www.surgerydoor.co.uk/), and comprises two parts. Part one outlines the literature on electronic health information evaluation. It discusses quality issues, but also redresses the imbalance by exploring other evaluative perspectives. Part two describes an evaluative of a health information Internet site in terms of its usability and appeal, undertaken as part of a Department of Health funded study on the impact of such systems. [ABSTRACT FROM AUTHOR]

The article discusses the use of Internet as a means of communication, research and continuing education in medicine. A review of the strengths and weaknesses of Internet-based methods is offered. Also included is the result of electronic mail surveys on clinical works of public health physicians in Great Britain.

The article describes Activheart, a free web-based behavioural intervention programme intended to help patients improve or maintain their health following a National Health Service health check. The programme offers ongoing psychological and social support based on a pace they themselves have set. An alliance between the Primary Care Cardiovascular Society, Heart UK and Flora pro.activ. led to the development of the program.

Objectives: To evaluate the performance of a Conformitée Européenne (CE)-marked home test for Chlamydia trachomatis (CT) that is available over the internet. Methods: A total of 231 eligible women attending the Social Hygiene Clinic (SHC) or Obstetrics-Gynecology (OB-GYN) Clinic in Iloilo City, Philippines were recruited to an evaluation of the HandiLab-C Chlamydia home test (HandiLab-C). One vaginal swab was tested with HandiLab-C on-site and the second in Cambridge, UK with two nucleic acid amplification tests (NAAT), the Roche Amplicor and Abbott m2000. The organism load of NAAT-positive swabs was quantified. Results: Concordance between the NAATs was high (kappa agreement: 0.984). Using the Abbott assay as the gold standard, the sensitivity and specificity of the Roche assay were 97.4% and 100%, respectively. CT prevalence by Abbott was 8.0% (8/100) in the OB-GYN Clinic and 23.7% (31/131) at SHC. The sensitivity of HandiLab-C was 12.5% (1/8) and 19.4% (6/31) in OB-GYN and SHC respectively, with specificities of 93.5% (86/92) and 88% (88/100) respectively. Overall positive and negative predictive values of HandiLab-C were 28% and 84.5% respectively. No correlation between HandiLab-C performance and organism load (range: 1.3x102 to 1.4x107 bacteria/swab) was observed. Conclusions: The performance of HandiLab-C is very poor, with the test yielding more false-positive (18/193) than true-positive (7/38) results. It remains accessible via the internet under various brand names and has retained its CE mark. This situation raises serious concerns about the regulation of diagnostic products available via the internet and the standards of certain Notified Bodies that issue the CE mark. [ABSTRACT FROM AUTHOR]

Hadley and Hadfield (2006)1 discussed the steps being undertaken to launch a managed learning environment (MLE) in a large acute NHS Trust. The MLE was formally launched to a range of Trust staff in the spring of 2007. This paper considers the development of a formally classroom-based programme into one offering a blended approach. The Beacon Leadership programme chosen for this mode of learning is a high-profile course for clinical inter professional managers and aims to meet one of the key Trust objectives, to 'relentlessly improve patient experience and safety'. The programme has been developed in house and is only delivered to North Bristol Trust staff. This paper explores the development, instigation and evaluation of MLE use during the Beacon programme. [ABSTRACT FROM AUTHOR]

Background: Routine influenza surveillance, based on laboratory confirmation of viral infection, often fails to estimate the true burden of influenza-like illness (ILI) in the community because those with ILI often manage their own symptoms without visiting a health professional. Internet-based surveillance can complement this traditional surveillance by measuring symptoms and health behavior of a population with minimal time delay. Flusurvey, the UK's largest crowd-sourced platform for surveillance of influenza, collects routine data on more than 6000 voluntary participants and offers real-time estimates of ILI circulation. However, one criticism of this method of surveillance is that it is only able to assess ILI, rather than virologically confirmed influenza.Objective: We designed a pilot study to see if it was feasible to ask individuals from the Flusurvey platform to perform a self-swabbing task and to assess whether they were able to collect samples with a suitable viral content to detect an influenza virus in the laboratory.Methods: Virological swabbing kits were sent to pilot study participants, who then monitored their ILI symptoms over the influenza season (2014-2015) through the Flusurvey platform. If they reported ILI, they were asked to undertake self-swabbing and return the swabs to a Public Health England laboratory for multiplex respiratory virus polymerase chain reaction testing.Results: A total of 700 swab kits were distributed at the start of the study; from these, 66 participants met the definition for ILI and were asked to return samples. In all, 51 samples were received in the laboratory, 18 of which tested positive for a viral cause of ILI (35%).Conclusions: This demonstrated proof of concept that it is possible to apply self-swabbing for virological laboratory testing to an online cohort study. This pilot does not have significant numbers to validate whether Flusurvey surveillance accurately reflects influenza infection in the community, but highlights that the methodology is feasible. Self-swabbing could be expanded to larger online surveillance activities, such as during the initial stages of a pandemic, to understand community transmission or to better assess interseasonal activity. [ABSTRACT FROM AUTHOR]

The article discusses the author's views about the impacts that online (digital) communications and opinions involving social media are having on the transformation of medical care in Great Britain as of 2017, and it mentions the British Care Opinion Ltd. non-profit organization which built an Internet-based platform which allows individuals to share their experiences with health and care services. The health care-related attitudes of patients are assessed.

Background: Concerns over online health information-seeking behavior point to the potential harm incorrect, incomplete, or biased information may cause. However, systematic reviews of health information have found few examples of documented harm that can be directly attributed to poor quality information found online.Objective: The aim of this study was to improve our understanding of the quality and quality characteristics of information found in online discussion forum websites so that their likely value as a peer-to-peer health information-sharing platform could be assessed.Methods: A total of 25 health discussion threads were selected across 3 websites (Reddit, Mumsnet, and Patient) covering 3 health conditions (human immunodeficiency virus [HIV], diabetes, and chickenpox). Assessors were asked to rate information found in the discussion threads according to 5 criteria: accuracy, completeness, how sensible the replies were, how they thought the questioner would act, and how useful they thought the questioner would find the replies.Results: In all, 78 fully completed assessments were returned by 17 individuals (8 were qualified medical doctors, 9 were not). When the ratings awarded in the assessments were analyzed, 25 of the assessments placed the discussion threads in the highest possible score band rating them between 5 and 10 overall, 38 rated them between 11 and 15, 12 rated them between 16 and 20, and 3 placed the discussion thread they assessed in the lowest rating band (21-25). This suggests that health threads on Internet discussion forum websites are more likely than not (by a factor of 4:1) to contain information of high or reasonably high quality. Extremely poor information is rare; the lowest available assessment rating was awarded only 11 times out of a possible 353, whereas the highest was awarded 54 times. Only 3 of 78 fully completed assessments rated a discussion thread in the lowest possible overall band of 21 to 25, whereas 25 of 78 rated it in the highest of 5 to 10. Quality assessments differed depending on the health condition (chickenpox appeared 17 times in the 20 lowest-rated threads, HIV twice, and diabetes once). Although assessors tended to agree on which discussion threads contained good quality information, what constituted poor quality information appeared to be more subjective.Conclusions: Most of the information assessed in this study was considered by qualified medical doctors and nonmedically qualified respondents to be of reasonably good quality. Although a small amount of information was assessed as poor, not all respondents agreed that the original questioner would have been led to act inappropriately based on the information presented. This suggests that discussion forum websites may be a useful platform through which people can ask health-related questions and receive answers of acceptable quality. [ABSTRACT FROM AUTHOR]

We designed a study to evaluate the feasibility, acceptability and effectiveness of an Internet-based self-management system for diabetes. The Virtual Clinic allows a patient to communicate with health professionals, find information and participate in peer-to-peer discussions. Three focus groups were conducted with patients, and there were six interviews with health-care professionals and an expert workshop to gather consensus. All the people who were consulted were enthusiastic about the Virtual Clinic concept and perceived clear benefits in terms of improved self-management. The principal study design problems were: (1) choice and design of intervention; (2) outcome measures; (3) how much of the study is Internet-based; (4) data security and confidentiality. Our results suggest that a well-designed intervention study is possible. It will allow the evaluation of the feasibility, acceptability and effectiveness of the intervention in the context of the UK National Health Service. [ABSTRACT FROM AUTHOR]

DATA SOURCES:Sources of studies were the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials, Medline, Embase, Scisearch, SIGLE (System for Information on Grey Literature in Europe) CAplus¥, INSPEC*, JICST-EPLUS?, NTIS?, PASCAL?, Database of Abstracts and Reviews (DARE), the UK National Health Service Economic Evaluation Database and Health Technology Assessment database. Reference lists from included articles and review articles were searched for additional relevant publications. All relevant studies in most languages were considered and translated. STUDY SELECTION:Articles were selected for inclusion in the review if they were randomised or quasi-randomised controlled trials of at least 12 months in duration and if sealants were used for preventing caries in children and adolescents of under 20 years of age. Both parallel group and split-mouth study designs were included. The primary outcome was the increment in the numbers of carious occlusal surfaces of premolars and molars. DATA EXTRACTION AND SYNTHESIS:In the first phase, two reviewers independently examined whether a given study was likely to be relevant on the basis of the title, keywords and abstract. In the second phase, four of the reviewers independently classified whether studies would be included in final analyses. Study authors were contacted for additional information. In the split-mouth studies, relative risk (RR) ratios were calculated for the paired differences of tooth surfaces being carious or not. In studies that compared resin-based sealant with no treatment, fixed-effect meta-analyses were used to combine the estimates of RR ratios. In one parallel-group study, the effect-estimate was calculated from data of occlusal surfaces of teeth included in the test and control groups. RESULTS:Eight trials were included in this review, of which seven were split-mouth studies and one a parallel-group study. Six studies provided data for comparing sealant with no treatment and three studies compared glass ionomers (GI) with resin-based sealants. The overall effectiveness of resin-based sealants in preventing dental decay on first molars was high. Based on five split-mouth studies with 5-10-year-old children there were significant differences in favour of the second-generation resin sealant compared with no treatment. Pooled RR values were 0.14, 0.24, 0.30 and 0.43 at 12, 24, 36 and 48-54 months, respectively. The reductions in caries therefore ranged from 86%at 12 months to 57%at 48-54 months. The 24-month parallel group study that compared second-generation resin sealant with control in 12-13-year old children also found significantly more caries in the control group children with a DFS of 0.65 (95%confidence interval, 0.47-0.83). Allocation concealment was classified as adequate in three of these six studies. The information on background levels of caries in the population, however, was insufficient to conduct further analyses that would allow an estimate of the effect of resin-based sealants related to baseline caries prevalence. Only one study provided data for the comparison of GI sealant and control. Based on this, there is not enough information to say whether GI sealants are effective or not. The results of three studies comparing resin sealants with GI sealants were conflicting and the meta-analyses were not carried out. CONCLUSIONS:Sealing with resin-based sealants is recommended to prevent caries of the occlusal surfaces of permanent molars but we recommend that the caries prevalence level of both the individual and population should be taken into account. In practice, the benefit of sealing should be considered locally and specific guidelines for clinicians should be used. The methodological quality of published studies concerning pit and fissure sealants was poorer than expected.Evidence-Based Dentistry (2004) 5, 93-94. doi:10.1038/sj.ebd.6400292 [ABSTRACT FROM AUTHOR]

Reports on the increasing use of the Internet by medical voluntary groups in the field of neurology in Great Britain. Contribution to the democratization of health-related information; Use of the Internet for research, advertising and fund raising.

Background: Most households in the United Kingdom have Internet access, and health-related Internet use is increasing. The National Health Service (NHS) Direct website is the major UK provider of online health information. Objective: Our objective was to identify the characteristics and motivations of online health information seekers accessing the NHS Direct website, and to examine the benefits and challenges of the health Internet. Methods: We undertook an online questionnaire survey, offered to users of the NHS Direct website. A subsample of survey respondents participated in in-depth, semistructured, qualitative interviews by telephone or instant messaging/email. Questionnaire results were analyzed using chi-square statistics. Thematic coding with constant comparison was used for interview transcript analysis. Results: In total 792 respondents completed some or all of the survey: 71.2% (534/750 with data available) were aged under 45 years, 67.4% (511/758) were female, and 37.7% (286/759) had university-level qualifications. They sought information for themselves (545/781, 69.8%), someone else (172/781, 22.0%), or both (64/781, 8.2%). Women were more likely than men to seek help for someone else or both themselves and someone else (168/509 vs 61/242, χ²[sub 2] = 6.35, P = .04). Prior consultation with a health professional was reported by 44.9% (346/770), although this was less common in younger age groups (<36 years) (χ²[sub 1] = 24.22, P < .001). Participants aged 16 to 75 years (n = 26, 20 female, 6 male) were recruited for interview by telephone (n = 23) and instant messaging/email (n = 3). Four major interview themes were identified: motivations for seeking help online; benefits of seeking help in this way and some of the challenges faced; strategies employed in navigating online health information provision and determining what information to use and to trust; and specific comments regarding the NHS Direct website service. Within the motivation category, four concepts emerged: the desire for reassurance; the desire for a second opinion to challenge other information; the desire for greater understanding to supplement other information; and perceived external barriers to accessing information through traditional sources. The benefits clustered around three theme areas: convenience, coverage, and anonymity. Various challenges were discussed but no prominent theme emerged. Navigating online health information and determining what to trust was regarded as a "common sense" activity, and brand recognition was important. Specific comments about NHS Direct included the perception that the online service was integrated with traditional service provision. Conclusions: This study supports a model of evolutionary rather than revolutionary change in online health information use. Given increasing resource constraints, the health care community needs to seek ways of promoting efficient and appropriate health service use, and should aim to harness the potential benefits of the Internet, informed by an understanding of how and why people go online for health. [ABSTRACT FROM AUTHOR]

The author ponders on the implications of the unmanageability of the Internet for medical practice in Great Britain. He cites the problems encountered by former Formula One executive Max Mosley and WikiLeaks editor in chief Julian Assange when their personal lives were revealed on the Internet. He claims that no technical barriers nor confidentiality protection governs Internet publication. However, the author says that the unmanageability of the Internet could provide some benefits to doctors and patients.

NHS Direct is introducing a range of patient self-assessment tools. Enid Povey explains their purpose and the impact they may have on healthcare services in the UK. [ABSTRACT FROM AUTHOR]

The author presents an outlook for a health care system in Great Britain after the global financial crisis. He explains that reason for the need for health services to focus on the carbon footprint consequences of their development. He discusses the notion of allocative efficiency which is characterized by deriving most value from the correction allocation of resources. He also calls on clinicians to campaign for more resources and the health care industry to harness the benefits of the Internet.

The article states that the "International Journal of Cosmetic Science," published for the Society of Cosmetic Chemists in Great Britain and the Societe Francaise de Cosmetologie in France, has now achieved Medline's PubMed indexing status which means that, manuscripts accepted from 2008 will be indexed, and will be searchable via the PubMed literature database which is the most widely used, search engine in science.

Support, advice and treatment for addictions seems very fragmented – there are a large number of Web sites that look at each addiction individually, but very few look at the topic in general. [ABSTRACT FROM AUTHOR]

The article comments on paper "Men who have sex with men in Britain: Comparison of a self-selected internet sample with a national probability sample," by A.R. Evans, R.D. Wiggins and colleagues. The study compares a self-selected internet sample of gay men with a national probability sample of men who have sex with men (MSM). It fills an important gap in the field of internet and MSM sampling. The role of the internet in HIV/sexually transmitted infection (STI) programs is cited.

Reports on a booklet for practice nurses produced by members of the Royal College of Nursing Travel Health Forum in Great Britain. Background on the forum; Recommendations from the booklet on appropriate time-slots to provide travel consultations; Need for those providing travel health services to be members of the forum and/or the British Travel Health Association; Use of a travel health Web site to provide medical services effectively.

Discusses the role of the mobile telephone in public health care in Great Britain. Use of Short Message Service (SMS) and text messaging facilities; Limitations associated with the use of internet and email access; How patients are encouraged to report on the quality and success of their treatments or interventions; Speculation that text messages may be used to alert patients of upcoming appointments.

Editorial. Focuses on changes to Great Britain's General Practice Research Database. Publication of research papers by GPRD; Plans to increase access to the database; How the Internet should make medical research easier.