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Confidentiality requirements of individuals and companies led to the dominance of encrypted payloads in the overall Internet traffic. Hence, traffic classification on a network became increasingly difficult as it must rely on only the packet headers. Many vital tasks such as differential pricing, providing a safe Internet for children, and eliminating malicious connections require traffic classification, even if the payload contents are encrypted. Encrypted traffic is harder to classify as packet content becomes unreadable. In this work, we aim to provide an insight into traffic classification using encrypted packets in terms of both accuracy and packet processing time. LSTM (Long Short-Term Memory) architecture is a good candidate for this problem as it can handle sequences. Each flow can be modeled as a sequence and patterns of the sequences can provide valuable information. We compare the performance of LSTM with other methods in both real-time and offline experiments. Compared to a machine learning method both online and offline LSTM excelled with precision and recall differences up to 50%. Average accuracy with LSTM was measured as 97.77% offline and 91.7% in real-time. Average packet processing time in real-time was recorded as 0.593 msec which is 5 times faster than a recent work that uses LSTM method. [ABSTRACT FROM AUTHOR]

After the introduction of the first robotic-assisted surgical procedures, the technology soon reached the world of endovascular specialists, giving rise to several publications about robotic-assisted endovascular therapy. Compared with conventional procedures, roboticassisted procedures can be more accurate and reduce radiation exposure. The latest commercially available endovascular robotic system is the CorPath GRX, which can be operated remotely. Robotic-assisted approaches have proved applicable in the fields of coronary and peripheral vascular intervention and neurointervention. Remote intervention has already proved feasible in the coronary and peripheral vascular systems and, according to expert opinion, could revolutionize acute stroke management as well. We review current knowledge about robotic-assisted therapies and remote interventions, and the future prospects and pitfalls. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the nature of knowledge exchange on a multi‐disciplinary Australasian intensive care virtual community of practice, "ICUConnect." Background: Current organisational structures and cultures constrain the social networks of healthcare professionals, limiting access to contemporary best practice knowledge. While virtual communities can facilitate knowledge and clinical expertise exchange in professional networks, their effectiveness has not been established. Design: A sequential mixed‐methods design with a quantitative core and qualitative supplementary component was used to explore the content of discussions from an intensive care virtual community. SRQR has been used to report this study. Methods: Email archives of an intensive care listserv (2003–2013) were mined using a two‐stage sampling technique to identify discussion threads (with >2 posts) concerning ventilator or airway practices (cluster) and two sets of 20 threads (stratified across years). Summative content analysis was used to examine both manifest and latent content. Results: Forty threads containing 326 emails posted by 133 individuals from 80 organisations were analysed. Nurses contributed 68% (55% were in clinical leadership roles) and physicians 27%. Three subject areas were identified: clinical practices (71%); equipment (23%); and clinical governance (6%). "Knowledge‐requested" and "knowledge‐supplied" posts were categorised as follows: experiential and explicit (33% and 16%, respectively); experiential (27% and 35%); or explicit (40% and 17%). Knowledge supplied was also categorised as "know‐how" (20%); "know‐why" (5%) or "no knowledge" exchanged (6%). The central construct of virtual community work was identified with six elements that facilitated participation and knowledge exchange including: (a) the discussion thread; (b) sharing of artefacts; (c) community; (d) cordiality; (e) maven work; and (f) promotion of the VC. Members asked questions to benchmark their practice, while those who answered were focused on ensuring that best practices were delivered. Conclusions: ICUConnect reflected characteristics of a virtual community of practice, enabling key benefits for members and the broader Australasian intensive care community, especially access to best practice knowledge from clinical experts. Relevance to clinical practice: This study demonstrated that a practice‐based VC can function effectively as a VCoP to establish an effective professional network where members have access to up‐to‐date best practice knowledge. Healthcare organisations could leverage VCs to support the professional development of HCPs and ensure that local clinical practices are based on contemporaneous knowledge. Participation by nurses in these communities facilitates individual professional development and access to important clinical knowledge and expertise, and ultimately reinforcing the unique position of nursing in delivering effective, consistent high‐quality patient care. [ABSTRACT FROM AUTHOR]

Objective: To support collation of data for disability determination, we sought to accurately identify facilities where care was delivered across multiple, independent hospitals and clinics.Methods: Data from various institutions' electronic health records were merged and delivered as continuity of care documents to the United States Social Security Administration (SSA).Results: Electronic records for nearly 8000 disability claimants were exchanged with SSA. Due to the lack of standard nomenclature for identifying the facilities in which patients received the care documented in the electronic records, SSA could not match the information received with information provided by disability claimants. Facility identifiers were generated arbitrarily by health care systems and therefore could not be mapped to the existing international standards.Discussion: We propose strategies for improving facility identification in electronic health records to support improved tracking of a patient's care between providers to better serve clinical care delivery, disability determination, health reform and meaningful use.Conclusion: Accurately identifying the facilities where health care is delivered to patients is important to a number of major health reform and improvement efforts underway in many nations. A standardized nomenclature for identifying health care facilities is needed to improve tracking of care and linking of electronic health records. [ABSTRACT FROM AUTHOR]

Background: Important barriers for widespread use of health information exchange (HIE) are usability and interface issues. However, most HIEs are implemented without performing a needs assessment with the end users, healthcare providers. We performed a user needs assessment for the process of obtaining clinical information from other health care organizations about a hospitalized patient and identified the types of information most valued for medical decision-making.Methods: Quantitative and qualitative analysis were used to evaluate the process to obtain and use outside clinical information (OI) using semi-structured interviews (16 internists), direct observation (750 h), and operational data from the electronic medical records (30,461 hospitalizations) of an internal medicine department in a public, teaching hospital in Tampa, Florida.Results: 13.7 % of hospitalizations generate at least one request for OI. On average, the process comprised 13 steps, 6 decisions points, and 4 different participants. Physicians estimate that the average time to receive OI is 18 h. Physicians perceived that OI received is not useful 33-66 % of the time because information received is irrelevant or not timely. Technical barriers to OI use included poor accessibility and ineffective information visualization. Common problems with the process were receiving extraneous notes and the need to re-request the information. Drivers for OI use were to trend lab or imaging abnormalities, understand medical history of critically ill or hospital-to-hospital transferred patients, and assess previous echocardiograms and bacterial cultures. About 85 % of the physicians believe HIE would have a positive effect on improving healthcare delivery.Conclusions: Although hospitalists are challenged by a complex process to obtain OI, they recognize the value of specific information for enhancing medical decision-making. HIE systems are likely to have increased utilization and effectiveness if specific patient-level clinical information is delivered at the right time to the right users. [ABSTRACT FROM AUTHOR]

The problem of finding and keeping updated shortest paths in distributed networks is considered crucial in today's practical applications. In the recent past, there has been a renewed interest in devising new efficient distance-vector algorithms as an attractive alternative to link-state solutions for large-scale Ethernet networks, in which scalability and reliability are key issues or the nodes can have limited storage capabilities. In this paper, we present Distributed Computation Pruning ( DCP), a new technique, which can be combined with every distance-vector routing algorithm based on shortest paths, allowing to reduce the total number of messages sent by that algorithm and its space occupancy per node. To check its effectiveness, we combined the new technique with DUAL (Diffuse Update ALgorithm), one of the most popular distance-vector algorithm in the literature, which is part of CISCO's widely used EIGRP protocol, and with the recently introduced LFR (Loop Free Routing) which has been shown to have good performances on real networks. We give experimental evidence that these combinations lead to a significant gain both in terms of number of messages sent and of memory requirements per node. [ABSTRACT FROM AUTHOR]

Objective To simply analyze the reasons of positive rate fluctuation in influenza-like illness(ILI) nucleic acid detection by the contrast of ILI monitoring results in the same period in order to ensure the accuracy and reliability of network laboratory nucleic acid detection results and timely prevent the occurrence of flu outbreak.Methods According to the National Influenza Surveillance Information System,the annual 1-10 weeks testing data of influenza in the Yongchuan District of Chongqing City during 2014—2017 were collected for conducting the contrastive analysis.The nasopharyngeal swab samples of flu cases and previous positive samples of nucleic acid detection were randomly extracted.Then nucleic acid was extracted by using the nucleic acid extracting reagent kits from the Shuoshi Biotechnology Co.,Ltd and automatic nucleic acids extraction apparatus,nucleic acid extracting reagent kits from the Shanghai Zhijiang Biotechnology Co.,Ltd and EX2400 automatic nucleic acids extraction apparatus,and the manual nucleic acid extraction.Real-time fluorescent PCR was used to conduct the comparative analysis on the detection results.Results The ILI proportions in the first 10 weeks during 2014-2017 were 0.70%,0.67%,0.53% and 0.40% respectively,the difference was statistically significant compared with ILI at the same period(χ~2=56.556,P<0.05).The ILI proportion had statistically significant difference between the 0-<5 years old group and 5-<15 years old group(χ~2=27.753,13.480,P<0.05).The positive rate of nucleic acid detection at the first 10 weeks of each year had large difference among different years.The abnor-mal phenomenon occurred in 2017.The re-detection was performed by adopting 3 different nucleic acid extraction methods.The detection results were coincident with that in the National Influenza Surveillance Information System reported by the flu network laboratory of Yongchuan District of Chongqing City after the first time detection.No mistake report and missed report situation was coincident.Conclusion When the flu network laboratory personnel find the positive rate fluctuation or abnormality,should attach great importance to analyze the reasons,conduct the comparison with the experiment at the same period in each year and speculate the prevalent trend. [ABSTRACT FROM AUTHOR]

Objective Exploring the characteristics information of high-risk populations of undergraduate depression from social networks and tracking the high-risk groups of depression to provide the key points for the administration department of the college students and give more psychological support or psychological aid for them. Methods (1) SNS was focused on the target populations; (2)Preliminary searching keywords(PSK) were selected characterizing expression; (3)Determine keywords for a disposable searching: recorded the result, 10 high frequency used words were filtered. as the final searching keywords ( FSK); (4)Formal searching was the non-reprinted text messages with students' view in detail in the ' status' column for consecutive 7 days with FSK. (5)Text database established: name, gender, school and text that "status" covered. (6)Depressive characteristic keywords (DCK) positioned: to determine representative DCK used by college students by the detection rate sorted during retrieval in continuous 7 days. Results The DCK was related to depression. The FSK detection rate from high to low was respectively as follows: suicide (3.80%), depression (1.80%), escape (1.80), lazyness (1.71%), insomnia (1.50%), futility (1.22%), pain (1.00%), crying (1.00%), despair (0.83%), loneliness (0.60%). The overall DCK detection rate was 1.35%. Conclusion College students' depression characteristics exists in the SNS. The high-risk depression populations could be found by DCK search, which make psychological support and aids. [ABSTRACT FROM AUTHOR]

Patients have been able to access clinical information from their paper-based health records for a number of years. With the advent of Electronic Medical Records (EMRs) access to this information can now be achieved online using a secure electronic patient portal. The purpose of this study was to investigate maternity patients' use and perceptions of a patient portal developed at the Mater Mothers' Hospital in Brisbane, Australia. A web-based patient portal, one of the first developed and deployed in Australia, was introduced on 26 June 2012. The portal was designed for maternity patients booked at Mater Mothers' Hospital, as an alternative to the paper-based Pregnancy Health Record. Through the portal, maternity patients are able to complete their hospital registration form online and obtain current health information about their pregnancy (via their EMR), as well as access a variety of support tools to use during their pregnancy such as tailored public health advice. A retrospective cross-sectional study design was employed. Usage statistics were extracted from the system for a one year period (1 July 2012 to 30 June 2013). Patients' perceptions of the portal were obtained using an online survey, accessible by maternity patients for two weeks in February 2013 (n=80). Descriptive statistics were employed to analyse the data. Between July 2012 and June 2013, 10,892 maternity patients were offered a patient portal account and access to their EMR. Of those 6,518 created one (60%; 6,518/10,892) and 3,104 went on to request access to their EMR (48%; 3,104/6,518). Of these, 1,751 had their access application granted by 30 June 2013. The majority of maternity patients submitted registration forms online via the patient portal (56.7%). Patients could view their EMR multiple times: there were 671 views of the EMR, 2,781 views of appointment schedules and 135 birth preferences submitted via the EMR. Eighty survey responses were received from EMR account holders, (response rate of 8.1%; 80/985). The majority of respondents indicated they would use the portal and access their EMR for future pregnancies (86.2%; 69/80). Approximately half looked at their EMR after a visit with their care provider (51.3%); 41/80) and 37.5% (30/80) viewed their EMR before, to prepare for their visit. The majority (65.8%) thought that the EMR improved their ability to understand and recall appointments and almost half (48.1%) thought that with the EMR they were less likely to repeat pregnancy information to caregivers. This study provides the first Australian evidence of a patient portal system, tied to an EMR, working effectively in a maternity care context. It provides new evidence that portals can deliver benefits to maternity patients in terms of providing quick and easy access to current personal and general health information and support patients in their ability to recall and prepare for appointments. [ABSTRACT FROM AUTHOR]

Objective: Public health organizations increasingly face the need to be able to share data among themselves and ultimately with other providers. We examined what factors contribute to public health organizations' data exchange capabilities.Data Sources: National Association of County and City Health Officials' 2008 National Profile of Local Health Departments survey was linked to the Association of State and Territorial Health Official's 2007 Profile of State Public Health Survey.Study Design: We conducted a cross-sectional analysis of organizational factors associated with gaps in data sharing between state health agencies (SHAs) and local health departments (LHDs) in the areas of childhood immunizations, vital records, and reportable conditions.Data Collection: Based on reported information system (IS) capabilities, we created a binary variable that measured whether bidirectional data sharing was structurally possible between an LHD and its respective SHA.Principal Findings: The proportion of LHDs experiencing a data sharing gap was 34.0 percent for immunizations, 69.8 percent for vital records, and 81.8 percent for reportable conditions. Increased SHA technological capacity and size reduced the odds of gaps.Conclusions: Improving the IS capabilities of public health agencies may be the key to their remaining relevant in the currently evolving health care system. [ABSTRACT FROM AUTHOR]

Objective Public health organizations increasingly face the need to be able to share data among themselves and ultimately with other providers. We examined what factors contribute to public health organizations' data exchange capabilities. Data Sources National Association of County and City Health Officials' 2008 National Profile of Local Health Departments survey was linked to the Association of State and Territorial Health Official's 2007 Profile of State Public Health Survey. Study Design We conducted a cross-sectional analysis of organizational factors associated with gaps in data sharing between state health agencies ( SHAs) and local health departments ( LHDs) in the areas of childhood immunizations, vital records, and reportable conditions. Data Collection Based on reported information system ( IS) capabilities, we created a binary variable that measured whether bidirectional data sharing was structurally possible between an LHD and its respective SHA. Principal Findings The proportion of LHDs experiencing a data sharing gap was 34.0 percent for immunizations, 69.8 percent for vital records, and 81.8 percent for reportable conditions. Increased SHA technological capacity and size reduced the odds of gaps. Conclusions Improving the IS capabilities of public health agencies may be the key to their remaining relevant in the currently evolving health care system. [ABSTRACT FROM AUTHOR]

In this age of unprecedented expansion of media and information dissemination and sharing, the use of electronic means should be reconsidered. The use of new technologies should be studied to understand how it may affect the relationship between patient and therapist during psychotherapy or psychoanalytic treatments. This study offers a critical discussion of the effect of technologies on clinical practice, and vignettes are used to describe their impact on frame, anonymity, abstinence and therapeutic neutrality. Transfer and countertransference issues resulting from these changes are also discussed. The potential benefits of new technologies in psychotherapy are appreciated, but the authors draw attention to the need to reflect about the presence of the therapist in those technologies and the preservation of the therapeutic setting, so that a satisfactory progression of the work of the dyad is ensured. This study also discusses the use of technologies in the expansion of learning and application of the therapeutic technique to overcome geographic and time barriers, among others. [ABSTRACT FROM AUTHOR]

Background: The use of online social networks (OSNs) among physicians and physicians-in-training, the extent of patient-doctor interactions within OSNs, and attitudes among these groups toward use of OSNs is not well described.Objective: To quantify the use of OSNs, patient interactions within OSNs, and attitudes toward OSNs among medical students (MS), resident physicians (RP), and practicing physicians (PP) in the United States.Design/setting: A random, stratified mail survey was sent to 1004 MS, 1004 RP, and 1004 PP between February and May 2010.Measurements: Percentage of respondents reporting OSN use, the nature and frequency of use; percentage of respondents reporting friend requests by patients or patients' family members, frequency of these requests, and whether or not they were accepted; attitudes toward physician use of OSNs and online patient interactions.Results: The overall response rate was 16.0% (19.8% MS, 14.3% RP, 14.1% PP). 93.5% of MS, 79.4% of RP, and 41.6% of PP reported usage of OSNs. PP were more likely to report having visited the profile of a patient or patient's family member (MS 2.3%, RP 3.9%, PP 15.5%), and were more likely to have received friend requests from patients or their family members (MS 1.2%, RP 7.8%, PP 34.5%). A majority did not think it ethically acceptable to interact with patients within OSNs for either social (68.3%) or patient-care (68.0%) reasons. Almost half of respondents (48.7%) were pessimistic about the potential for OSNs to improve patient-doctor communication, and a majority (79%) expressed concerns about maintaining patient confidentiality.Conclusion: Personal OSN use among physicians and physicians-in-training mirrors that of the general population. Patient-doctor interactions take place within OSNs, and are more typically initiated by patients than by physicians or physicians-in-training. A majority of respondents view these online interactions as ethically problematic. [ABSTRACT FROM AUTHOR]

Information and Communication Technology (ICT) solutions (e.g. e-health, telemedicine, e-education) are often viewed as vehicles to bridge the digital divide between rural and urban healthcare centres and to resolve shortcomings in the rural health sector. This study focused on factors perceived to infl uence the uptake and use of ICTs as e-health solutions in selected rural Eastern Cape healthcare centres, and on structural variables relating to these facilities and processes. Attention was also given to two psychological variables that may underlie an individual's acceptance and use of ICTs: usefulness and ease of use. Recommendations are made with regard to how ICTs can be used more effectively to improve health systems at fi ve rural healthcare centres where questionnaire and interview data were collected: St. Lucy's Hospital, Nessie Knight Hospital, the Tsilitwa Clinic, the Madzikane Ka-Zulu Memorial Hospital and the Nelson Mandela General Hospital. [ABSTRACT FROM AUTHOR]

A recent innovation to help patients adhere to daily tuberculosis (TB) treatment over many months is video (or virtually) observed therapy (VOT). VOT is becoming increasingly feasible as mobile telephone applications and tablet computers become more widely available. Studies of the effectiveness of VOT in improving TB patient outcomes are being conducted. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the response rates to Web-based survey and paper-based survey implemented across 3 practice-based research networks (PBRNs). During the study, the survey was implemented electronically with 5 rounds of electronic solicitation for an Internet-based questionnaire and 2 rounds of a paper-based version. It was found that 24 percent of the total survey responses were received in the paper mode despite intense promotion.

Abstract: Objective: To compare how nurses in two different paper-based systems perceive the impact of a computerized physician order entry (CPOE) system on their medication-related activities. Setting: 13 non-surgical, adult inpatient wards in a Dutch academic hospital. Methods: Questionnaire survey of 295 nurses before and 304 nurses after the implementation of a CPOE system. These nurses worked with two different paper-based medication systems before the implementation: ‘Kardex-system’ and ‘TIMED-system’. In the Kardex-system, the structure of the nursing medication work was similar to that of after the CPOE implementation, while in the TIMED-system, it was different. ‘Adaptive Structuration Theory’ (AST) was used to interpret the results. Results: The response rates were 52.2% (154/295) before and 44.7% (136/304) after the implementation. Kardex-nurses reported more positive effects than TIMED-nurses. TIMED-nurses reported that the computerized system was more inflexible, more difficult to work with, and slower than the TIMED-system. In the TIMED group, the overall mean score of the computerized process was not significantly different from that of the paper-based process. Moreover, nurses in both groups were more satisfied with the post-implementation process than with the pre-implementation process. Nevertheless, none of groups reported a better workflow support in the computerized system when compared to that of the paper-based systems. Conclusions: Our findings suggest that not only the technology but also large differences between pre- and post-implementation work structure influence the perceptions of users, and probably make the transition more difficult. This study also suggests that greater satisfaction with a system may not necessarily be a reflection of better workflow support. [Copyright &y& Elsevier]

Abstract: Purpose: From the Hippocratic Oath to the World Medical Association''s Declaration of Geneva, physicians have sworn to protect patients’ privacy. However, as systems move to more integrated architectures, protecting this medical data becomes more of a challenge. The increase in complexity of IT environments, the aggregation of data, and the desire of other entities to access this data, often 24h/day×7day/week×365day/year, is putting serious strains on our ability to maintain its security. This problem cuts across all electronic record sources from patient care records to academic medical research records. Approach: In order to address this issue, we are rethinking the way we store, transmit, process, access, and federate patient data from clinical and research applications. Our groups at the University of Michigan are developing a system called the “Honest Broker” to help manage this problem. The Honest Broker will offload the burden of housing identifiable data elements of protected health information (PHI) (e.g., name and address) as well as manage data transfer between clinical and research systems. Lab results and other non-identifiable data will be stored in separate systems with either a research study ID or clinical ID number. This two-component architecture increases the burden on attackers who now need to compromise two systems, one of which is seriously hardened, in order to match health data with a patient''s actual identity. Conclusions: While no security system is truly intrusion-proof, this architecture provides a high security choke point reducing the likelihood of a breach. By redesigning the method of integrating clinical care and research, we have enabled projects that would be cost prohibitive to conduct otherwise. The scalability of this mechanism is dependant on nature of the heterogenous nature of the clinical systems serving patients. [Copyright &y& Elsevier]

Abstract: Objective: Today, there are many barriers that prevent seamless electronic voice and data communication with remote content and services that the user wants to access at a certain time and place. This is especially the case in hospitals, where the communication needs are very complex and context dependent, and where strict privacy and safety conditions apply. Personal network (PN) technology is expected to enable the various private networks of a single person to communicate seamlessly with each other, hiding underlying network complexity from the user. We have analyzed the usefulness of PNs in hospitals. Methods: We studied the use case of a medical emergency surgery, and built a demonstrator by integrating models of the specialists’ personal area networks, home networks, office networks, and a hospital network into a single virtual network. We performed user studies in various hospitals, using a combination of individual context interviews, scenario and requirements verification, guided experimenting with the demonstrator and concluding workshops. Results: We show that, in case of medical emergencies, PNs can provide a means to enlist remote assistance from peers wherever they are in the world at a particular moment. It can also ease the communication between the operating theatre and the outside world, e.g. for educational purposes. [Copyright &y& Elsevier]

Abstract: Interest in self-reported measures of depression in clinical trials has grown in recent years. This study compared the reliability and validity of the clinician-administered Montgomery-Asberg Depression Rating Scale (MADRS) to a computer-administered version administered over the telephone using Interactive Voice Response (IVR) technology. Sixty subjects were administered both the clinician- and computer-administered versions of the MADRS in a counter-balanced order. A subsample of 20 patients was reassessed 24h later by both methods. Mean score differences between IVR and clinician were not statistically significant (<1 point) and a high correlation was found between forms (r =.815, p <.001). Reliability measures (Cronbach’s Alpha and 24-h test–retest) were comparable. Clinicians rated the severity of subjects’ sadness and pessimistic thoughts lower than subjects self-report. The data obtained in this pilot study provide support for the equivalence between the clinician and IVR versions of the MADRS. [Copyright &y& Elsevier]

UniNet is an Internet-based thematic network for a virtual community of users (VCU). It supports one multidisciplinary community of doctoral students, who receive most of the courses on the network. The evident advantages of distance learning by Internet, in terms of costs, comfort, etc., require a previous evaluation of the system, focusing on the learning outcomes of the student. The aim was to evaluate the real learning of the students of doctorate courses, by comparing the effectiveness of distance learning in UniNet with traditional classroom-based teaching. Five doctorate courses were taught simultaneously to two independent groups of students in two ways: one, through the UniNet Network, and the other in a traditional classroom. The academic knowledge of students was evaluated at the beginning and end of each course. The difference in score was considered as a knowledge increase. The comparison was made using Student's t -test for independent groups. There were no significant statistical differences in the outcomes of the two groups of students. This suggests that both teaching systems were equivalent in increasing the knowledge of the students. Both educational methods, the traditional system and the online system in a thematic network, are effective and similar for increasing knowledge. [ABSTRACT FROM AUTHOR]

Summary: Objective: The purpose of this study is to compare whether students’ learning outcomes would be better in a designed learning environment (WebCT) than in a conventional web site (WWW) with similar course material but without special learning tools. Context: Third-year medical students in an introductory course on medical informatics at the University of Helsinki, Finland. Methods: Students were randomly assigned to a WebCT group (n =39) and a WWW group (n =46). The students in the WebCT group utilized the course material in general discussion groups, special discussions about lectures, quizzes and students’ own notes. The WWW group had access only to the course material. The learning outcome was assessed by administering an on-line examination and the learning experience of the students was assessed by an on-line quiz. Results: The course grade was significantly higher in the WebCT group as compared to the WWW group. This finding was more prominent among females. The students of the WebCT group also experienced significantly more improvement in collaboration with the use of computers than the students in the WWW group. Conclusions: Based on our results, web-based learning seems to be more effective when students are provided with specially designed learning tools. [Copyright &y& Elsevier]

Summary: Objective:: To determine use, appreciation and effectiveness of an electronic health information support system in head and neck (H&N) cancer care. Design:: A prospective evaluation study. The evaluated system has four different functions: (1) communication amongst health care providers and between health care providers and patients, (2) information for health care providers and patients, (3) contact with fellow sufferers and (4) monitoring of discharged patients by means of electronic questionnaires. Evaluation of the system was done both objectively using automatically created log files and stored messages, and subjectively by using paper questionnaires from patients and general practitioners (GPs). Setting:: Department of Otorhinolaryngology and Head and Neck Surgery of a tertiary health care centre in the Netherlands. The system was put at patients’ disposal for a period of 6 weeks following discharge from the hospital after surgery for H&N cancer, and was additional to standard care. Participants:: Head and neck cancer patients, hospital physicians, members of a hospital-based support team, GPs, district nurses and speech therapists. Main outcome measures:: Actual use of the system by patients and health care providers. Patients’ appreciation for each of the system''s four different functions. GPs’ appreciation for the system. Capability to detect potential patient problems with the system. Results:: The system was used by 36 H&N cancer patients, 10 hospital physicians, 2 members of the support team, 8 GPs, 2 district nurses and 2 speech therapists. The total number of patient-sessions was 982: an average of 27.3 sessions per patient during the 6 weeks study period. In total, 456 monitoring questionnaires were completed. The support team in hospital responded with 231 actions. In 16 cases, an extra appointment was made for a patient with the hospital physician. Out of these cases, immediate action was considered necessary eight times. Patients appreciated the system highly, rating it with an average score of 8.0 on a 10-point scale. All patients used the monitoring function, and rated ‘monitoring’ with a mean score of 8.0 on a 10-point scale. Least used and appreciated was the ‘contact with fellow sufferers’ function. Only 8 out of possible 36 GPs used the system, rating it with an average of 5.6 on a 10-point scale. Conclusions:: The electronic health information support system was used intensively and highly appreciated by H&N cancer patients. The system enabled the early detection of occurring health problems that required direct intervention. ICT can play an additional role in the management of patients, also in a relatively elderly and computer illiterate patient population. [Copyright &y& Elsevier]

Summary: Problem: : Although electronic communication of clinical data between various actors in the healthcare domain seems crucial for a cost-effective patient treatment, it is mostly restricted to paper based documents. In order to meet the growing need for improved data communication, it is necessary to overcome the barriers of software heterogeneity and lack of standards, especially in cross-institutional shared care communication. HL7''s clinical document architecture (CDA) is a new and promising tool to exchange any clinical document. In this paper we show how CDA can be used to (1) share electronic discharge letters and other clinical data generated and stored in the hospitals electronic patient record (EPR) with general practitioners and (2) to transfer these clinical data to a personal electronic health record (EHR). The latter scenario is in routine use. Ease-of-use and data security and integrity were the main design principles in both scenarios. Methods: : Within the electronic patient record a data extraction and exporting mechanism has been built. For both scenarios appropriate data processing and transmission methods have been developed, and the receiving information systems have been prepared for the CDA based data input. Results: : Although there still remain technical and organizational issues to be solved, this is a promising method in order to enhance data exchange between hospital and primary care and to move towards an electronic patient record (EPR) and an electronic health record (EHR) crossing institutional borders. This paper describes the design and current implementation and discusses our experiences. [Copyright &y& Elsevier]

Summary: Objectives:: To model and implement web portals providing access to certified and high-quality information in the domain of health. Material and methods:: The Unified Medical Language System (UMLS) knowledge sources of the U.S. National Library of Medicine and principles of implementation resulting from the previous ARIANE project are described. The XML technology that allows files transformations by the means of XSLT is briefly presented. Results:: The design and implementation of software modules that exploit knowledge sources, operate the translation of a user''s query to selected information sources, and wrap obtained results are detailed. Querying documentary and factual medical databases are presented. Discussion:: Current implementation and wrapping perspectives are discussed in terms of integration and interoperability of health information and data resources. [Copyright &y& Elsevier]

Summary: Objectives:: The objectives of this study were to assess patients’ willingness to use e-mail to obtain specific test results, assess their expectations regarding response times, and identify any demographic trends. Methods:: A cross-sectional survey of primary care patients was conducted in 19 clinics of a large multi-specialty group practice associated with an 186,000-member Health Maintenance Organization. The outcome measures were proportion of patients with current e-mail access, their willingness to use it for selected general clinical services and to obtain specific test results, and their expectations of timeliness of response. Results:: The majority of patients (58.3%) reported having current e-mail access and indicated strong willingness to use it for communication. However, only 5.8% reported having ever used it to communicate with their physician. Patients were most willing to use e-mail to obtain cholesterol and blood sugar test results, but less willing to use it to obtain brain CT scan results. Patients’ expectations of timeliness were generally very high, particularly for high-stakes tests such as brain CT scan. Significant differences of willingness and expectations were found by age group, education, and income. Conclusions:: These findings indicate that most patients are willing to use e-mail to communicate with their primary care providers even for specific test results and that patients will hold providers to high standards of timeliness regarding response. The implication is that integration of e-mail communications into primary care ought to assure prompt and accurate patient access to a plethora of specific clinical services. [Copyright &y& Elsevier]

Starting as a small military and academic network, the Internet has gradually evolved into a worldwide web, which connects most local networks as well as millions of personal computers from individual users. It is of interest to the medical practitioner, that ever more biomedical resources are becoming available on-line to assist in clinical medicine, research and education. In this paper a detailed list of the World Wide Web sites accessible through the Internet is provided, in which data about newborn hearing screening may be found. Web resources of medical equipment and suppliers and sites including otoacoustic emissions topics, are presented as well. This review is intended to present the wealth of the accessible information on the Internet and to promote further presentation on the web of any available hearing screening data from hospitals and Audiology Departments in which such programs are implemented. [Copyright &y& Elsevier]

The Internet''s global reach offers new powerful tools to professionals in Occupational and Environmental Health (OEH). The World Wide Web includes extensive free and commercially available reference materials on toxicology, regulatory issues, environmental epidemiology and prevention programs. Much of this especially useful content is inaccessible to general Web-based search engines. Effective use of the Web requires discovery and familiarity with sites housing query engines for technical databases. Although the Web''s structure and capacity is so dynamic that any listing is incomplete, introductions to many resources are provided in this article. The Internet also offers professionals electronic access to one another, for collegial discourse. Electronic mailing lists provide assembly points for collaboration and guidance about technical issues. Several specialty forums for OEH professionals are also discussed. [Copyright &y& Elsevier]

The Internet=s global reach offers new powerful tools to professionals in Occupational and Environmental Health (OEH). The World Wide Web includes extensive free and commercially available reference materials on toxicology, regulatory issues, environmental epidemiology and prevention programs. Much of this especially useful content is inaccessible to general Web-based search engines. Effective use of the Web requires discovery and familiarity with sites housing query engines for technical databases. Although the Web=s structure and capacity is so dynamic that any listing is incomplete, introductions to many resources are provided in this article. The Internet also offers professionals electronic access to one another, for collegial discourse. Electronic mailing lists provide assembly points for collaboration and guidance about technical issues. Several specialty forums for OEH professionals are also discussed. [Copyright &y& Elsevier]

Administrative communication is increasingly challenging for residency programs as the number of training sites expands. The Internet provides a cost-effective opportunity to address these needs. Using the World Wide Web, we developed a single, reliable, accurate, and accessible source of administrative information for residents, faculty, and staff in a multisite internal medicine residency at reduced costs. Evaluation of the effectiveness of the website was determined by tracking website use, materials and personnel costs, and resident, staff, and faculty satisfaction. Office supply and personnel costs were reduced by 89% and personnel effort by 85%. All users were highly satisfied with the web communication tool and all reported increased knowledge of program information and a greater sense of "connectedness." We conclude that an internet-based communication system that provides a single, reliable, accurate, and accessible source of information for residents, faculty, and staff can be developed with minimum resources and reduced costs. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Many health care providers and patients are exploring the feasibility of using E-mail to address a variety of medical issues. We wanted to determine the proportion of our patient population with E-mail access, determine their willingness to use this technology to expedite communication with health care providers, and assess their expectations of response times. STUDY DESIGN: A cross-sectional, in-person prevalence survey. POPULATION Patients (n=950) with scheduled appointments to see a primary care provider in 6 of 18 family practice clinics in a large health care delivery system in central Texas. OUTCOMES MEASURED: The proportion of patients with E-mail access, their willingness to use it, and their expectations regarding the timeliness of responses to their E-mail queries about selected clinical services. RESULTS: Overall, 54.3% of the patients reported having E-mail access, with significant variation among the 6 clinics (33%-75%). Reported areas of strongest desire for using E-mail were to request prescription refills (90%), for nonurgent consultations (87%), and to obtain routine laboratory results or test reports (84%). Patients' expectations regarding the timeliness of responses to their E-mail queries varied by clinical service. For laboratory results, their expectations were: less than 9 hours, 21%; 9 to 24 hours, 53%; and more than 24 hours, 26%. CONCLUSIONS: Most patients attending family practice clinics in central Texas have E-mail access and indicate they would use it to request prescription refills, for nonurgent consultations, and to obtain routine laboratory results or test reports. Regardless of sex or race, patients have high expectations that these tasks can be completed within a relatively short time. [ABSTRACT FROM AUTHOR]

BACKGROUND. The World Wide Web (Web) has the potential to revolutionize information retrieval in medicine. However, the best method of information retrieval from the Web is not known. The purpose of our study was to compare medical search engines, general-purpose search engines, medical metalists, and commercial sites on the Web with regard to their efficiency in retrieving medical information. METHODS. Ten questions were identified from a database of questions posed by primary care clinicians. Authoritative answers were identified. Searches were performed using 1 commercial site, 4 general search engines, 9 medicine-specific search engines, and 2 medical meta-lists. The main outcome measures were the number of questions answered by each Web site, the correctness of the answers, the number of links followed to get an answer, and how well documented the answer was using the Health on the Net criteria. RESULTS. MD Consult, a commercial site, answered 6 of 10 questions. Hardin MD (a meta-list) and Excite and HotBot (general search engines) each answered 5 questions. The medicine-specific search engines performed poorly, answering an average of only 1 question. MD Consult and HotBot required the least number of links to find an answer. MD Consult and Hardin MD had the best documented answers. CONCLUSIONS. Medicine-specific search engines on the Web fare poorly in answering clinical questions when compared with general search engines. MD Consult, Excite, HotBot, and Hardin MD found the greatest number of answers. [ABSTRACT FROM AUTHOR]

The application of queueing network models to the performance analysis of message-switched (or packet-switched) communication networks is surveyed. The main topics covered are the analysis of end-to-end delay and the analysis of buffer management schemes. A brief discussion on flow control is also included. A queueing network model is developed for a simple user-resource network. The mean response time of a host computer in this network is illustrated by a numerical example. [ABSTRACT FROM AUTHOR]

Objectives: 1. Promoting safe and easy communication between patient and healthcare providers. 2. Involve the patient in the control and monitoring of their health 3. Encourage no-face appointments. 4. Minimize bureaucracy in health centers. Description: We offer our adult users, after signing informed consent, secure access to a web 2.0 platform, which allows them, from any device connected to the network,. The platform allows them to safely view most of his updated medical record, with printing capabilities (analytics, vaccination program), possibility to interact with his doctor and nurse (send and receive e-mails with attachments, request appointment or ask them for a call) leaving them pending on the professional calendar, access to medication and print updated electronic prescription, request and print temporary disability notes, monitoring of chronic diseases, and others. Conclusions: From January 2013 all professionals with assigned quota in center have registered and 1985 patients (8,1% of assigned population), of whom 1581 (80%) have used it. The 58246 activities performed (average of 32 accesses/day and 1,7 activities / access) by users have been mainly for bureaucracy issues (60%) such printing of prescripted medication (20%), schedule a visit in the center (12%), print disability notes (19%), analytics (4%), but also to communicate with the professional (22%), especially with emails (21%), and 19% of searching clinical information, with medical records queries (14%) and health controls (4%). Applicability: This may mean a progressive cultural change in terms of patient accessibility to health practitioners, as well as the efficiency of the actions of professionals who will avoid face-to-face appointments that are unnecessary and bureaucratic, and on the other side will see their distance activities reflected in their daily agenda. Health managers, meanwhile, will be provided with knowledge of the actual activity of health care professionals and will have more information to better plan workloads. Further studies are needed to assess patient adherence to the platform and the changes that may represent the use of health care resources and health outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Background: Electronic health record (EHR) systems are often modified through the addition of new features over time. Few studies have examined the specific effects of such changes. We examined whether implementation of a bidirectional laboratory interface for order entry and data reporting within an existing ambulatory EHR would result in more prompt responses to laboratory indications for antiretroviral therapy (ART) changes or in improved communication with HIV+ patients about relevant laboratory results. Methods: We conducted a single-arm intervention study comparing the timeliness of ART regimen changes, HIV viral load (VL) outcomes and patient-reported assessments of care before and after implementation of a laboratory data exchange interface within an existing EHR, without changing the EHR ordering or results reporting user interface. Patient data was extracted from the EHR covering the period from 1 year before to 2 years after the intervention for a cohort of 1181 patients who had received care during the baseline year. The timeliness of ART changes was represented by the days from a laboratory-result “signal” (CD4 dropping below 350 or 200 or VL increasing by a half-log or to a value over 100,000) to an ART-change “response”. Patient assessments of care were collected by interviewing 100 anonymous patients at baseline and another 125 at 2 years post-intervention. Results: A total of 171 laboratory “signal” events were followed within 80 days by a change in ART therapy. The mean time from signal to therapy change (adjusted for clustering by patient) initially increased, from 37.7 days during the pre-intervention year to 48.2 days during the quarter immediately following activation of the lab intervention. It then declined to a mean of 31.4 days over the remaining 21 months of observation (P =0.03 for the 6-day improvement from the pre-period). A majority of patients (65%) achieved undetectable VL values by the end of the observation period; faster signal–response times were not associated with greater achievement of undetectable VL. Patients rated communication about laboratory tests more highly after implementation of the interface (91 vs. 83 on a 100-point scale, P =0.01); ratings were not higher for other aspects of care. Conclusions: Adding laboratory data exchange interfaces within existing EHRs holds promise for improving HIV care, both in the timeliness of responses to important laboratory results and in the quality of provider communication about lab tests. However, the benefits from this incremental change may be modest unless more extensive redesign of laboratory follow-up workflows is undertaken, with support from enhanced user interfaces that take advantage of the laboratory information delivered. Providers should also consider increased staffing to compensate for dips in follow-up performance during the initial post-implementation months. [Copyright &y& Elsevier]

Abstract: Purpose: This paper presents research on the interplay of health information technology (HIT), quality improvement and progression of health status. The purpose of the research was to determine whether electronic exchange of health information impacts quality of care and, by extension, health outcomes of patients with HIV/AIDS. The research was supported as a demonstration project under the Information Technology Networks of Care Initiative sponsored by the U.S. Health Resources and Services Administration, HIV/AIDS Bureau, Special Projects of National Significance (SPNS). The City of Paterson, New Jersey, Department of Health and Human Services administered the project as the grant recipient, secured and managed through the City of Paterson''s Ryan White Part A Program of Bergen and Passaic Counties. Methods: We implemented a web-based health information support system, e2, to facilitate rigorous quality improvement activities associated with care and treatment of HIV/AIDS patients. We used e2 to monitor patient care in the clinic setting. We observed five quality and two health status indicators relating to the care of 263 HIV/AIDS medical patients at three HIV/AIDS medical clinics from 2008 to 2010. The quality indicators conformed to HIV/AIDS Bureau (HAB) Groups 1 and 2 definitions of two or more CD4 T-cell counts performed in the measurement year, AIDS patients prescribed HAART, two or more medical visits in the measurement year, PCP prophylaxis administered to AIDS patients with CD4 T-cell counts <200, and adults screened for syphilis within the measurement year. CD4 T-cell count and viral load suppression indicators were used as health status indicators. Frequency analysis and logistic generalized estimating equations were used to assess correlation. We also assessed user satisfaction with e2 as a quality improvement tool using qualitative methods. Results: Availability of the e2 system was a leading contributing factor in successful quality management activities, leading to improved quality of care and health status of HIV/AIDS patients across all three clinics. Significant improvements were observed in three of the five quality indicators and in both of the two health status indicators. Conclusions: We conclude that health information technology as a tool for rigorous application of quality improvement methods can positively impact quality of care and health outcomes. We found that health outcomes improved over time when quality improvement methods were initiated and facilitated by a responsive electronic information support system. [Copyright &y& Elsevier]