A web exercise in evidence-based medicine using cognitive theory.
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Our aim was to improve clinical reasoning skills by applying an established theory of memory, cognition, and decision making (fuzzy-trace theory) to instruction in evidence-based medicine. Decision-making tasks concerning chest pain evaluation in women were developed for medical students and internal medicine residents. The fuzzy-trace theory guided the selection of online sources (e.g., target articles) and decision-making tasks. Twelve students and 22 internal medicine residents attended didactic conferences emphasizing search, evaluation, and clinical application of relevant evidence. A 17-item Likert scale questionnaire assessed participants' evaluation of the instruction. Ratings for each of the 17 items differed significantly from chance in favor of this alternative approach to instruction. We concluded that fuzzy-trace theory may be a useful guide for developing learning exercises in evidence-based medicine. (+info)
Small-group CME using e-mail discussions. Can it work?
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PROBLEM BEING ADDRESSED: Traditional continuing medical education (CME) approaches do not work well in changing physicians' behaviour, but some promising strategies and technologies might help. Our program sought to meld small-group learning with an Internet e-mail approach. OBJECTIVE OF PROGRAM: In 1994, the Family medicine Education and Research Network (FERN) was developed to support on-line discussion among London, Ont, and area family physicians. To support educational, moderated case discussions using e-mail, FERN Dissemination (FERN-D) was introduced to a subgroup of participants. We hoped to increase awareness and use of evidence-based research in clinical practice and to increase use of Internet-based resources for CME. The target group was family physicians in the London area. MAIN COMPONENTS OF PROGRAM: Forty volunteers were recruited and were e-mailed one case every 2 weeks; 34 completed the study. Each case was followed by further postings and, at the end of 2 weeks, by a summary of the group's discussion. Background material for each case was researched and was evidence-based. Evaluation was conducted using preintervention and postintervention mailed surveys combined with an e-mail feedback questionnaire and a modified focus group. CONCLUSION: On-line case-based discussion is a promising strategy for encouraging family physicians to access current research. More research is needed to determine whether it can be effectively used to change physicians' practice. (+info)
Randomised trial of personalised computer based information for patients with schizophrenia.
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OBJECTIVES: To compare use, effect, and cost of personalised computer education with community psychiatric nurse education for patients with schizophrenia. DESIGN: Randomised trial of three interventions. Modelling of costs of alternatives. PARTICIPANTS: 112 patients with schizophrenia in contact with community services; 67 completed the intervention. INTERVENTIONS: Three interventions of five educational sessions: (a) computer intervention combining information from patient's medical record with general information about schizophrenia; (b) sessions with a community psychiatric nurse; (c) "combination" (first and last sessions with nurse and remainder with computer). MAIN OUTCOME MEASURES: Patients' attendance, opinions, change in knowledge, and psychological state; costs of interventions and patients' use of NHS community services; modelling of costs for these three, and alternative, interventions. RESULTS: Rates of completion of intervention did not differ significantly (71% for combination intervention, 61% for computer only, 46% for nurse only). Computer sessions were shorter than sessions with nurse (14 minutes v 60 minutes). More patients given nurse based education thought the information relevant. Of 20 patients in combination group, 13 preferred the sessions with the nurse and seven preferred the computer. There were no significant differences between groups in psychological outcomes. Because of the need to transport patients to the computer for their sessions, there was no difference between interventions in costs, but computer sessions combined with other patient contacts would be substantially cheaper. CONCLUSIONS: The computer based patient education offered no advantage over sessions with a community psychiatric nurse. Investigation of computer use combined with other health service contacts would be worth while. (+info)
Adobe acrobat: an alternative electronic teaching file construction methodology independent of HTML restrictions.
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The goal of the project was to create a method by which an in-house digital teaching file could be constructed that was simple, inexpensive, independent of hypertext markup language (HTML) restrictions, and appears identical on multiple platforms. To accomplish this, Microsoft PowerPoint and Adobe Acrobat were used in succession to assemble digital teaching files in the Acrobat portable document file format. They were then verified to appear identically on computers running Windows, Macintosh Operating Systems (OS), and the Silicon Graphics Unix-based OS as either a free-standing file using Acrobat Reader software or from within a browser window using the Acrobat browser plug-in. This latter display method yields a file viewed through a browser window, yet remains independent of underlying HTML restrictions, which may confer an advantage over simple HTML teaching file construction. Thus, a hybrid of HTML-distributed Adobe Acrobat generated WWW documents may be a viable alternative for digital teaching file construction and distribution. (+info)
Creating a Web-accessible, point-of-care, team-based information system (PointTIS): the librarian as publisher.
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The Internet has created new opportunities for librarians to develop information systems that are readily accessible at the point of care. This paper describes the multiyear process used to justify, fund, design, develop, promote, and evaluate a rehabilitation prototype of a point-of-care, team-based information system (PoinTIS) and train health care providers to use this prototype for their spinal cord injury and traumatic brain injury patient care and education activities. PoinTIS is a successful model for librarians in the twenty-first century to serve as publishers of information created or used by their parent organizations and to respond to the opportunities for information dissemination provided by recent technological advances. (+info)
User's guide to tuberculosis resources on the internet.
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The World Wide Web has become a source of information for clinicians and researchers about virtually every aspect of tuberculosis (TB). We provide information about TB-related Internet portal sites. We classify selected TB-related Web pages according to user needs. The questions that we address are as follows: (1) Where can I find scientific information about TB? (2) Where can I find epidemiologic data? (3) Where can I find literature for laypeople? (4) Where can I find recommendations, guidelines, and clinical decision-making algorithms for management of TB? (5) Where can I find research databases? (6) Where can I find research groups? (7) Where can I find resources for research, teaching, and training? (8) Where can I find information about regulatory action? The total number of TB-related Web pages is immense, their scope is vast, and their content is perpetually changing. Nonetheless, the sites identified here provide the reader with a manageable number of entry points to this increasingly important resource. (+info)
The medical school Web site: medical education's newest tool.
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There are few technological advancements that have had as much impact on the dissemination of information as the Internet, and especially the worldwide web. It is not surprising then that this tool is also changing the way medicine is studied, taught and practiced today. This impressive infrastructure enables us to teach and study medicine in an entirely different way. The web provides medical students and physicians with access to continuing medical education, patient education services, telemedicine, and unparalleled communication between colleagues via email. The medical school web site may be used as a dynamic newspaper or bulletin board to disseminate information internally among the faculty as well as to the outside world. It can also be the vehicle for virtual learning modules that enhance the medical school core curriculum by including lectures, exercises, tests, etc. In addition, the web allows the student access to medical literature, medical software applications and medical resource depots. To date no work has been published on the medical school web site, its construction process, and its advantages, drawbacks and future. The purpose of this article is to examine the evolution of the web as a tool for medical schools, medical students and associated physicians. We discuss the building of a web site for a medical faculty, and look to the future. (+info)
Multicenter randomized evaluation of a nutritional education software in obese patients.
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OBJECTIVE: To study the efficacy of the nutritional education software, Nutri-Expert, in the management of obese adult patients. MATERIAL AND METHODS: Two groups of obese patients were followed up over one year in a randomized study: the first group received close traditional management (seven nutritional visits over the year, with physicians and dietitians conjointly) and the second one also used at home by Minitel the Nutri-Expert system. 557 patients were enrolled in the study by 16 French centers of diabetology and nutrition. Body mass index (BMI), tests of dietetic knowledge, dietary records and centralized biological measurements were assessed at inclusion, 6 and 12 months. 341 patients were evaluable at the end of the year. RESULTS: The group using Nutri-Expert scored significantly better in the tests of dietetic knowledge than the control group. For all patients, nutritional education led to a significant improvement in BMI, dietary records and biological measurements, without significant difference between the two groups. Five years after the end of the study, the weight of 148 patients was recorded; mean BMI was significantly lower than the initial value but there was no significant difference between the two groups. CONCLUSION: In the management of obese patients, Nutri-Expert system has a role to play in reinforcing nutritional knowledge; if regular follow-up is not possible, or if a large series of obese patients is to be treated, Nutri-Expert could partly replace traditional management, for example between visits. (+info)