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Development and usage of wiki-based software for point-of-care emergency medical information
Abstract
Objective:
To describe the creation and evaluate the usage of the first medical wiki linked to dedicated mobile applications.
Methods:
With the support of multiple current and past contributors, we developed an emergency medicine wiki linked to offline mobile applications (WikEM) in 2009. First deployment was at the Harbor-UCLA Medical Center emergency medicine residency program, with the wiki later opened to public use. To evaluate the project, we performed a post hoc analysis of system use and surveyed 8 years of current and past residents. Outcomes included website and application analytics, as well as survey analysis by composite response categories.
Results:
Over the 6-year period of this project, the wiki grew to over 7250 pages and 45 500 edits. The website receives more than 85 000 user sessions per month, with over 150 million page views to date. There have been over 200 000 installs of the mobile applications, progressing to produce over 5000 mobile sessions daily. Of potential survey respondents, 87.7% (107) completed the Internet-based survey. Among those who contributed to the wiki, 74.6% reported that it benefited their understanding of core emergency medicine content. Of program graduates, the vast majority reported use of the wiki as a resource after residency (93.8%) along with improvement in clinical efficiency (89.7%). Residents reported higher use and a more favorable opinion of wiki usefulness compared to graduates (P < .001).
Conclusions:
A wiki paired with mobile applications is beneficial for resident education and useful in post-residency clinical practice.
... Wikis allow people not only to consume content but also to produce and edit knowledge [27,28]. In the health care context, wikis (eg, WikEM [29] and Canadian Computerized Provider Order Entry Toolkit [30]) allow knowledge users (eg, physicians and administrators) to create and maintain a knowledge base that can quickly adapt to the local context at a low cost [26,31]. Wikis offer several advantages, including an immediate access to new or updated knowledge and interinstitutional integration [10][11][12][13][14]26]. ...
BACKGROUND
Clinical decision support systems are information technologies that assist clinicians in making better decisions. Their adoption has been limited because their content is difficult to adapt to local contexts and slow to adapt to emerging evidence. Collaborative writing applications such as wikis have the potential to increase access to existing and emerging evidence-based knowledge at the point of care, standardize emergency clinical decision making, and quickly adapt this knowledge to local contexts. However, little is known about the factors influencing health professionals’ use of wiki-based knowledge tools.
OBJECTIVE
This study aims to measure emergency physicians’ (EPs) and other acute care health professionals’ (ACHPs) intentions to use wiki-based knowledge tools in trauma care and identify determinants of this intention that can be used in future theory-based interventions for promoting the use of wiki-based knowledge tools in trauma care.
METHODS
In total, 266 EPs and 907 ACHPs (nurses, respiratory therapists, and pharmacists) from 12 Quebec trauma centers were asked to answer a survey based on the theory of planned behavior (TPB). The TPB constructs were measured using a 7-point Likert scale. Descriptive statistics and Pearson correlations between the TPB constructs and intention were calculated. Multiple linear regression analysis was conducted to identify the salient beliefs.
RESULTS
Among the eligible participants, 57.1% (152/266) of EPs and 31.9% (290/907) of ACHPs completed the questionnaire. For EPs, we found that attitude, perceived behavioral control (PBC), and subjective norm (SN) were significant determinants of the intention to use wiki-based knowledge tools and explained 62% of its variance. None of the sociodemographic variables were related to EPs’ intentions to use wiki-based knowledge tools. The regression model identified two normative beliefs ("approval by physicians" and "approval by patients") and two behavioral beliefs ("refreshes my memory" and "reduces errors"). For ACHPs, attitude, PBC, SN, and two sociodemographic variables (profession and the previous personal use of a wiki) were significantly related to the intention to use wiki-based knowledge tools and explained 60% of the variance in behavioral intention. The final regression model for ACHPs included two normative beliefs ("approval by the hospital trauma team" and "people less comfortable with information technology"), one control belief ("time constraints"), and one behavioral belief ("access to evidence").
CONCLUSIONS
The intentions of EPs and ACHPs to use wiki-based knowledge tools to promote best practices in trauma care can be predicted in part by attitude, SN, and PBC. We also identified salient beliefs that future theory-based interventions should promote for the use of wiki-based knowledge tools in trauma care. These interventions will address the barriers to using wiki-based knowledge tools, find ways to ensure the quality of their content, foster contributions, and support the exploration of wiki-based knowledge tools as potential effective knowledge translation tools in trauma care.
... Wikis allow people not only to consume content but also to produce and edit knowledge [27,28]. In the health care context, wikis (eg, WikEM [29] and Canadian Computerized Provider Order Entry Toolkit [30]) allow knowledge users (eg, physicians and administrators) to create and maintain a knowledge base that can quickly adapt to the local context at a low cost [26,31]. Wikis offer several advantages, including an immediate access to new or updated knowledge and interinstitutional integration [10][11][12][13][14]26]. ...
Background
Clinical decision support systems are information technologies that assist clinicians in making better decisions. Their adoption has been limited because their content is difficult to adapt to local contexts and slow to adapt to emerging evidence. Collaborative writing applications such as wikis have the potential to increase access to existing and emerging evidence-based knowledge at the point of care, standardize emergency clinical decision making, and quickly adapt this knowledge to local contexts. However, little is known about the factors influencing health professionals’ use of wiki-based knowledge tools.
Objective
This study aims to measure emergency physicians’ (EPs) and other acute care health professionals’ (ACHPs) intentions to use wiki-based knowledge tools in trauma care and identify determinants of this intention that can be used in future theory-based interventions for promoting the use of wiki-based knowledge tools in trauma care.
Methods
In total, 266 EPs and 907 ACHPs (nurses, respiratory therapists, and pharmacists) from 12 Quebec trauma centers were asked to answer a survey based on the theory of planned behavior (TPB). The TPB constructs were measured using a 7-point Likert scale. Descriptive statistics and Pearson correlations between the TPB constructs and intention were calculated. Multiple linear regression analysis was conducted to identify the salient beliefs.
Results
Among the eligible participants, 57.1% (152/266) of EPs and 31.9% (290/907) of ACHPs completed the questionnaire. For EPs, we found that attitude, perceived behavioral control (PBC), and subjective norm (SN) were significant determinants of the intention to use wiki-based knowledge tools and explained 62% of its variance. None of the sociodemographic variables were related to EPs’ intentions to use wiki-based knowledge tools. The regression model identified two normative beliefs ("approval by physicians" and "approval by patients") and two behavioral beliefs ("refreshes my memory" and "reduces errors"). For ACHPs, attitude, PBC, SN, and two sociodemographic variables (profession and the previous personal use of a wiki) were significantly related to the intention to use wiki-based knowledge tools and explained 60% of the variance in behavioral intention. The final regression model for ACHPs included two normative beliefs ("approval by the hospital trauma team" and "people less comfortable with information technology"), one control belief ("time constraints"), and one behavioral belief ("access to evidence").
Conclusions
The intentions of EPs and ACHPs to use wiki-based knowledge tools to promote best practices in trauma care can be predicted in part by attitude, SN, and PBC. We also identified salient beliefs that future theory-based interventions should promote for the use of wiki-based knowledge tools in trauma care. These interventions will address the barriers to using wiki-based knowledge tools, find ways to ensure the quality of their content, foster contributions, and support the exploration of wiki-based knowledge tools as potential effective knowledge translation tools in trauma care.
... The interpretation of electrocardiograms can be taught using social networking sites [7]. Even an entire encyclopedia of core EM knowledge can be shared and continuously updated using a wiki-based platform [8]. The possibilities of the integration between SoMe and medical education are seemingly endless. ...
Background
Residency programs seek to incorporate various social media (SoMe) platforms into their educational curricula, yet little is known regarding the potential roadblocks towards implementation. Our objective was to assess the current utilization of SoMe platforms and identify common barriers to implementation by emergency medicine (EM) residency programs.
Methods
Members of the Council of Emergency Medicine Residency Directors (CORD) Information Technology (IT) Committee developed an anonymous survey distributed to representatives from EM residency programs using the “CORD Community” internet forum. Descriptive statistics including percentages for numerical data as well as Fisher’s exact test for categorical data were used to report results.
Results
We received 116 individual responses from faculty, fellows, and residents of EM residency programs. The most common institutional, departmental, technological and knowledge barriers identified were restricted access to blogs (12.9%), insufficient protected time (17.2%), insufficient IT support to host the platform (16.4%), and a lack of knowledge among faculty of how to utilize blogs (23.3%) respectively.
Ten respondents (8.6%) reported that their programs had not attempted to utilize any SoMe platforms. Community-based programs and smaller programs (<24 residents) were significantly more likely to identify barriers to SoMo use among this cohort.
Conclusion
Utilization of SoMe platforms for resident education by EM residency programs is increasingly common, but significant obstacles exist on many levels that prevent programs from leveraging these innovations for knowledge translation. This is particularly common for community-based and small residency programs. Awareness of these common barriers will allow institutions and programs to better anticipate and design solutions to overcome these obstacles.
... Today, there are a number of crowdsourced repositories being used in health care, such as WikiEM. 13 Targeted information dissemination was a challenge identified early in medicine. The prevalent method of creating listservs and mailing lists was initially effective for this purpose but was fraught with issues, such as difficulty in searching for previously shared content, inability to selectively engage with or mute conversations, and lack of enhanced user functions such as tagging, routing, and highlighting e-mails of interest. ...
Over the last decade, social media has transformed how we communicate in the medical community. Microblogging through platforms such as Twitter has made social media a vehicle for succinct, targeted, and innovative dissemination of content in critical care medicine. Common uses of social media in medicine include dissemination of information, knowledge acquisition, professional networking, and patient advocacy. Social media engagement at conferences represents all of these categories and is often the first time health-care providers are introduced to Twitter. Most of the major critical care medicine conferences, journals, and societies leverage social media for education, research, and advocacy, and social media users can tailor the inflow of content based on their own interests. From these interactions, networks and communities are built within critical care medicine and beyond, overcoming the barriers of physical proximity. In this review, we summarize the history and current status of health-care social media as it relates to critical care medicine and provide a primer for those new to health-care social media with a focus on Twitter, one of the most popular microblogging platforms.
... Children are the most avid transmitters of respiratory viral infections, and the information gained from syndromic surveillance in children's hospitals can complement decentralized sentinel surveillance systems in a meaningful way [133]. With the advent of rapid diagnostics and mobile health applications, it has now become possible to monitor virological and clinical end points in real time [134][135][136][137][138][139][140]. ...
Introduction: Influenza-Like Illness is a leading cause of hospitalization in children. Disease burden due to influenza and other respiratory viral infections is reported on a population level, but clinical scores measuring individual changes in disease severity are urgently needed.
Areas covered: We present a composite clinical score allowing individual patient data analyses of disease severity based on systematic literature review and WHO-criteria for uncomplicated and complicated disease. The 22-item ViVI Disease Severity Score showed a normal distribution in a pediatric cohort of 6073 children aged 0-18 years (mean age 3.13; S.D. 3.89; range: 0 to 18.79).
Expert commentary: The ViVI Score was correlated with risk of antibiotic use, hospitalization and intensive care and was used to track children with influenza, respiratory syncytial virus, human metapneumovirus, human rhinovirus, and adenovirus infections and is fully compliant with regulatory data standards. The ViVI Disease Severity Score mobile application allows physicians to measure disease severity at the point-of care thereby taking clinical trials to the next level.
... WikiEM, an emergency medicine wiki, was originally developed for residents at the Harbor-UCLA Medical Center emergency medicine program in 2009 and was also subsequently opened to the public in 2011. 8 Of the residents who contributed to WikiEM, 74.6% reported a positive impact on their understanding of emergency medicine content and 72.9% noted an improvement in their clinical efficiency. This wiki phenomenon has also expanded internationally, with the successful implementation of a Wiki Guide for Obstetric and Gynecology Trainees in Ireland. ...
The objective of this study was to compare the examination scores before and after implementation of a study program based on high yield topics on the Council of Resident Education in Obstetrics and Gynecology (CREOG) In-Training Examination. This prospective cohort study compared scores from academic years 2012 to 2014 of University of Hawai'i obstetrics and gynecology residents who participated in a directed study program based on selected high yield topics from the CREOG Test Item Summary Booklet. Topics were considered high yield if more than 75% of the program residents answered the topic questions incorrectly during the immediately preceding CREOG In-Training Examination administration. Residents were assigned topics to research and present at monthly teaching sessions. The presentations were made accessible in a wiki website. The intervention was initiated in 2012 and discontinued in 2013. The primary outcome was the difference among CREOG In-Training Examination scores before the study program, during the study program, and after the study program was discontinued. Only scores of residents who sat for all three exams were included. Eleven residents were present during the duration of the study period and sat for all three CREOG examinations. During the year of the educational activity, paired individual resident CREOG exams scores increased significantly from the 2012 CREOG administration (mean = 194.7) to the 2013 CREOG administration (mean = 208.2). These findings demonstrate that the CREOG Test Item Summary Booklet and the wiki platform can be used to effectively direct educational efforts resulting in improvements in CREOG examination performance.
Background
Free open access medical education (FOAM) has become an integral resource for medical school and residency education. However, questions of quality and inconsistent coverage of core topics remain. In this second entry of the SAEM Systematic Online Academic Resource (SOAR) series, we describe the application of a systematic methodology to identify, curate, and describe FOAM topics specific to endocrine, metabolic and nutritional disorders as defined by the 2016 Model of the Clinical Practice of EM (MCPEM).
Methods
We developed an automated algorithm to search 264 keywords derived from 9 subtopics within the MCPEM category in the FOAM Search (a customized FOAM search tool) and the Social Media index. The top 100 results were extracted for each keyword. Resources underwent a manual iterative screening process, and those relevant to endocrinology, metabolic or nutritional disorders and EM were evaluated with the revised Medical Education Translational Resources: Impact and Quality (rMETRIQ) tool.
Results
The search yielded 36,346 resources, of which 756 met the criteria for quality assessment. After rMETRIQ tool training, 4 raters demonstrated an average measured intraclass correlation coefficient of 0.94 (95% CI 0.88-0.97, p<0.001). 121 posts (16% of posts) covering 25 subtopics were identified as high quality (rMETRIQ ≥ 16). The most covered subtopic was potassium disorders, representing 15% of all posts. Subtopics that did not have a high-quality resource identified include metabolic alkalosis, respiratory alkalosis, fluid overload, phosphorus metabolism, hyperglycemia, malabsorption, malnutrition and thyroiditis. From most to least common, the overall target audience was: junior resident (91%), PGY1 resident (88%), senior resident (81%), clerk (64%), attending (50%), and pre-clerkship (9%).
Conclusions
We systematically identified, described, and curated FOAM resources for EM learners on the topic of endocrinology, metabolic and nutritional disorders. A final list of high-quality resources can guide trainees, educator recommendations, and FOAM authors.
Background:
Electronic decision support tools in anesthesiology practice have great value, including the potential for mobile applications to simplify delivery of best-practice guidelines.
Aims:
We sought to combine demographics with usage information to elucidate important patterns in the rate of use of the Society of Pediatric Anesthesia Critical Events Checklist, as measured by in-app accesses of the checklist via the freely available anesthesia calculator app anesthesiologist.
Methods:
We performed a retrospective analytic observational case-control study using analytics and survey data collected from the app. Users of the app were classified on the basis of whether or not they had accessed the checklist. This classification was used to perform logistic regression against a number of independent variables, including frequency of app use, country income level, professional role, rating of app importance, length of time in practice, group size, practice model, community served, and primary practice environment.
Results:
Individual app users practicing in low- and middle-income countries have a significantly higher rate of Society for Pediatric Anesthesia Critical Events Checklist utilization as compared with high-income countries. Rural practitioners had higher utilization of the checklist. Practice size did not affect the utilization of the checklist. The checklist was used for both provider learning and for just-in-time patient care.
Conclusion:
mHealth apps are invaluable resource in everyday clinical practice. Mobile app analytics and in-app survey data reveal variable penetration and applicability of such technology worldwide. mHealth apps may be particularly impactful in limited-resource areas, such as lower-income environments and rural communities.
Background
The rapid global adoption of mobile health (mHealth) smartphone apps by healthcare providers presents challenges and opportunities in medicine. Challenges include ensuring the delivery of high-quality, up-to-date and optimised information. Opportunities include the ability to study global practice patterns, access to medical and surgical care and continuing medical education needs.
Methods
We studied users of a free anaesthesia calculator app used worldwide. We combined traditional app analytics with in-app surveys to collect user demographics and feedback.
Results
31 173 subjects participated. Users were from 206 countries and represented a spectrum of healthcare provider roles. Low-income country users had greater rates of app use (p<0.001) and ascribed greater importance of the app to their practice (p<0.001). Physicians from low-income countries were more likely to adopt the app (p<0.001). The app was used primarily for paediatric patients. The app was used around the clock, peaking during times typical for first start cases.
Conclusions
This mHealth app is a valuable decision support tool for global healthcare providers, particularly those in more resource-limited settings and with less training. App adoption and use may provide a mechanism for measuring longitudinal changes in access to surgical care and engaging providers in resource-limited settings. In-app surveys and app analytics provide a window into healthcare provider behaviour at a breadth and level of detail previously impossible to achieve. Given the potentially immense value of crowdsourced information, healthcare providers should be encouraged to participate in these types of studies.
Background:
Collaborative writing applications (CWAs), such as wikis and Google Documents, hold the potential to improve the use of evidence in both public health and healthcare. Although a growing body of literature indicates that CWAs could have positive effects on healthcare, such as improved collaboration, behavioural change, learning, knowledge management, and adaptation of knowledge to local context, this has never been assessed systematically. Moreover, several questions regarding safety, reliability, and legal aspects exist.
Objectives:
The objectives of this review were to (1) assess the effects of the use of CWAs on process (including the behaviour of healthcare professionals) and patient outcomes, (2) critically appraise and summarise current evidence on the use of resources, costs, and cost-effectiveness associated with CWAs to improve professional practices and patient outcomes, and (3) explore the effects of different CWA features (e.g. open versus closed) and different implementation factors (e.g. the presence of a moderator) on process and patient outcomes.
Search methods:
We searched CENTRAL, MEDLINE, Embase, and 11 other electronic databases. We searched the grey literature, two trial registries, CWA websites, individual journals, and conference proceedings. We also contacted authors and experts in the field. We did not apply date or language limits. We searched for published literature to August 2016, and grey literature to September 2015.
Selection criteria:
We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-and-after (CBA) studies, interrupted time series (ITS) studies, and repeated measures studies (RMS), in which CWAs were used as an intervention to improve the process of care, patient outcomes, or healthcare costs.
Data collection and analysis:
Teams of two review authors independently assessed the eligibility of studies. Disagreements were resolved by discussion, and when consensus was not reached, a third review author was consulted.
Main results:
We screened 11,993 studies identified from the electronic database searches and 346 studies from grey literature sources. We analysed the full text of 99 studies. None of the studies met the eligibility criteria; two potentially relevant studies are ongoing.
Authors' conclusions:
While there is a high number of published studies about CWAs, indicating that this is an active field of research, additional studies using rigorous experimental designs are needed to assess their impact and cost-effectiveness on process and patient outcomes.
Cancer care involves extensive knowledge about numerous chemotherapy drugs and chemotherapy regimens. This information is constantly evolving, and there has been no freely available, comprehensive, centralized repository of chemotherapy information to date.
We created an online, freely accessible, ad-free, collaborative wiki of chemotherapy information entitled HemOnc.org to address the unmet need for a central repository of this information. This Web site was developed with wiki development software and is hosted on a cloud platform. Chemotherapy drug and regimen information (including regimen variants), as well as other information of interest to hematology/oncology professionals, is housed on the site in a fully referenced and standardized format. Accredited users are allowed to freely contribute information to the site.
From its inception in November 2011, HemOnc.org has grown rapidly and most recently has detailed information on 383 drugs and 1,298 distinct chemotherapy regimens (not counting variants) in 92 disease subtypes. There are regularly more than 2,000 visitors per week from the United States and international locations. A user evaluation demonstrated that users find the site useful, usable, and recommendable.
HemOnc.org is now the largest free source of chemotherapy drug and regimen information and is widely used. Future enhancements, including more metadata about drugs and increasingly detailed efficacy and toxicity information, will continue to improve the value of the resource.
Copyright © 2015 by American Society of Clinical Oncology.
In 2013Australia introduced Wiki-based Clinical Practice Guidelines for the Management ofAdult Onset Sarcoma.These guidelines utilized a customized MediaWiki software application for guideline development and are the first evidence-based guidelines for clinical management of sarcoma. This paper presents our experience with developing and implementing web-based interactive guidelines and reviews some of the challenges and lessons from adopting an evidence-based (rather than consensus-based) approach to clinical sarcoma guidelines. Digital guidelines can be easily updated with new evidence, continuously reviewed and widely disseminated. They provide an accessible method of enabling clinicians and consumers to access evidence-based clinical practice recommendations and, as evidenced by over 2000 views in the first four months after release, with 49% of those visits being from countries outside of Australia. The lessons learned have relevance to other rare cancers in addition to the international sarcoma community.
INTRODUCTION
For health professions learners of all levels, staying abreast of the literature can seem like an insurmountable task as the number of clinically oriented articles continues to grow at an
increasing rate.(1,2) Fortunately, there has been a veritable explosion of online secondary resources that endeavor to digest the expanding medical literature and present it in a format that is optimized for adult learners. Particularly in emergency medicine, these resources have been dubbed “free open access medical education,” also known as free open access meducation (FOAM).(3) The FOAM movement has figured prominently in the proliferation of blogs and podcasts made available online by practicing clinicians.(3,4) As an unintended consequence, learners must now contend with an exponentially expanding library of both primary literature and secondary online resources. To make effective use of this stream of knowledge, learners must filter and choose from myriad resources. Simple digital
tools can be used to organize and manage this otherwise overwhelming amount of information. This article outlines 5 strategies to help learners and practicing physicians stay abreast
of both foundational and cutting-edge literature by using digital solutions.
Since its launch in 2001, Wikipedia has become the most popular general reference site on the Internet and a popular source of health care information. To evaluate the accuracy of this resource, the authors compared Wikipedia articles on the most costly medical conditions with standard, evidence-based, peer-reviewed sources.
The top 10 most costly conditions in terms of public and private expenditure in the United States were identified, and a Wikipedia article corresponding to each topic was chosen. In a blinded process, 2 randomly assigned investigators independently reviewed each article and identified all assertions (ie, implication or statement of fact) made in it. The reviewer then conducted a literature search to determine whether each assertion was supported by evidence. The assertions found by each reviewer were compared and analyzed to determine whether assertions made by Wikipedia for these conditions were supported by peer-reviewed sources.
For commonly identified assertions, there was statistically significant discordance between 9 of the 10 selected Wikipedia articles (coronary artery disease, lung cancer, major depressive disorder, osteoarthritis, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, back pain, and hyperlipidemia) and their corresponding peer-reviewed sources (P<.05) and for all assertions made by Wikipedia for these medical conditions (P<.05 for all 9).
Most Wikipedia articles representing the 10 most costly medical conditions in the United States contain many errors when checked against standard peer-reviewed sources. Caution should be used when using Wikipedia to answer questions regarding patient care.
Disruptive technologies are revolutionising continuing professional development in emergency medicine and critical care (EMCC). Data on EMCC blogs and podcasts were gathered prospectively from 2002 through November 2013. During this time there was a rapid expansion of EMCC websites, from two blogs and one podcast in 2002 to 141 blogs and 42 podcasts in 2013. This paper illustrates the explosive growth of EMCC websites and provides a foundation that will anchor future research in this burgeoning field.
To describe the creation and evaluate the use of a wiki by medical residents, and to determine if a wiki would be a useful tool for improving the experience, efficiency, and education of housestaff.
In 2008, a team of medical residents built a wiki containing institutional knowledge and reference information using Microsoft SharePoint. We tracked visit data for 3 years, and performed an audit of page views and updates in the second year. We evaluated the attitudes of medical residents toward the wiki using a survey.
Users accessed the wiki 23,218, 35,094, and 40,545 times in each of three successive academic years from 2008 to 2011. In the year two audit, 85 users made a total of 1082 updates to 176 pages and of these, 91 were new page creations by 17 users. Forty-eight percent of residents edited a page. All housestaff felt the wiki improved their ability to complete tasks, and 90%, 89%, and 57% reported that the wiki improved their experience, efficiency, and education, respectively, when surveyed in academic year 2009-2010.
A wiki is a useful and popular tool for organizing administrative and educational content for residents. Housestaff felt strongly that the wiki improved their workflow, but a smaller educational impact was observed. Nearly half of the housestaff edited the wiki, suggesting broad buy-in among the residents.
A wiki is a feasible and useful tool for improving information retrieval for house officers.
The Internet has become an important health information resource for patients and the general public. Wikipedia, a collaboratively written Web-based encyclopedia, has become the dominant online reference work. It is usually among the top results of search engine queries, including when medical information is sought. Since April 2004, editors have formed a group called WikiProject Medicine to coordinate and discuss the English-language Wikipedia's medical content. This paper, written by members of the WikiProject Medicine, discusses the intricacies, strengths, and weaknesses of Wikipedia as a source of health information and compares it with other medical wikis. Medical professionals, their societies, patient groups, and institutions can help improve Wikipedia's health-related entries. Several examples of partnerships already show that there is enthusiasm to strengthen Wikipedia's biomedical content. Given its unique global reach, we believe its possibilities for use as a tool for worldwide health promotion are underestimated. We invite the medical community to join in editing Wikipedia, with the goal of providing people with free access to reliable, understandable, and up-to-date health information.
With the advent of Web 2.0 technologies, user-edited online resources such as Wikipedia are increasingly tapped for information. However, there is little research on the quality of health information found in Wikipedia.
To compare the scope, completeness, and accuracy of drug information in Wikipedia with that of a free, online, traditionally edited database (Medscape Drug Reference [MDR]).
Wikipedia and MDR were assessed on 8 categories of drug information. Questions were constructed and answers were verified with authoritative resources. Wikipedia and MDR were evaluated according to scope (breadth of coverage) and completeness. Accuracy was tracked by factual errors and errors of omission. Descriptive statistics were used to summarize the components. Fisher's exact test was used to compare scope and paired Student's t-test was used to compare current results in Wikipedia with entries 90 days prior to the current access.
Wikipedia was able to answer significantly fewer drug information questions (40.0%) compared with MDR (82.5%; p < 0.001). Wikipedia performed poorly regarding information on dosing, with a score of 0% versus the MDR score of 90.0%. Answers found in Wikipedia were 76.0% complete, while MDR provided answers that were 95.5% complete; overall, Wikipedia answers were less complete than those in Medscape (p < 0.001). No factual errors were found in Wikipedia, whereas 4 answers in Medscape conflicted with the answer key; errors of omission were higher in Wikipedia (n = 48) than in MDR (n = 14). There was a marked improvement in Wikipedia over time, as current entries were superior to those 90 days prior (p = 0.024).
Wikipedia has a more narrow scope, is less complete, and has more errors of omission than the comparator database. Wikipedia may be a useful point of engagement for consumers, but is not authoritative and should only be a supplemental source of drug information.
When the American Academy of Ophthalmology recognized the demand for a free online database of eye disease, it determined that the best way to meet this need was with an ophthalmologist-controlled wiki: EyeWiki. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.
Article
Many quantities of interest in medicine, such as anxiety or degree of handicap, are impossible to measure explicitly. Instead, we ask a series of questions and combine the answers into a single numerical value. Often this is done by simply adding a score from each answer. For example, the mini-HAQ is a measure of impairment developed for patients with cervical myelopathy.1 This has 10 items (table 1)) recording the degree of difficulty experienced in carrying out daily activities. Each item is scored from 1 (no difficulty) to 4 (can't do). The scores on the 10 items are summed to give the mini-HAQ score.
View this table:View PopupView InlineTable 1
Mini-HAQ scale in 249 severely impaired subjects
When items are used to form a scale they need to have internal consistency. The items should all measure the same thing, so they should be correlated with one another. A useful coefficient for assessing internal consistency is Cronbach's alpha.2 The formula is:
[This figure is not available.]
where k is the number of items, si2 is the variance of the ith item and sT2 is the variance of the total score formed by summing all the items. If the items are not simply added to make the score, but first multiplied by weighting coefficients, we multiply the item by its coefficient before calculating the variance si2. Clearly, we must have at least two items-that is k >1, or will be undefined.
The coefficient works because the variance of the sum of a group of independent variables is the sum of their variances. If the variables are positively correlated, the variance of the sum will be increased. If the items making up the score are all identical and so perfectly correlated, all the si2 will be equal and sT2 = k2 si2, so that si2/sT2 = 1/k and = 1. On the other hand, if the items are all independent, then sT2 = si2 and = 0. Thus will be 1 if the items are all the same and 0 if none is related to another.
For the mini-HAQ example, the standard deviations of each item and the total score are shown in the table. We have si2 = 11.16, sT2 = 77.44, and k = 10. Putting these into the equation, we have
[This figure is not available.]
which indicates a high degree of consistency.
For scales which are used as research tools to compare groups, may be less than in the clinical situation, when the value of the scale for an individual is of interest. For comparing groups, values of 0.7 to 0.8 are regarded as satisfactory. For the clinical application, much higher values of are needed. The minimum is 0.90, and =0.95, as here, is desirable.
In a recent example, McKinley et al devised a questionnaire to measure patient satisfaction with calls made by general practitioners out of hours.3 This included eight separate scores, which they interpreted as measuring constructs such as satisfaction with communication and management, satisfaction with doctor's attitude, etc. They quoted for each score, ranging from 0.61 to 0.88. They conclude that the questionnaire has satisfactory internal validity, as five of the eight scores had >0.7. In this issue Bosma et al report similar values, from 0.67 to 0.84, for assessments of three characteristics of the work environment.4
Cronbach's alpha has a direct interpretation. The items in our test are only some of the many possible items which could be used to make the total score. If we were to choose two random samples of k of these possible items, we would have two different scores each made up of k items. The expected correlation between these scores is .
References1.↵Casey ATH, Crockard HA, Bland JM, Stevens J, Moskovich R, Ransford AO.Development of a functional scoring system for rheumatoid arthritis patients with cervical myelopathy Ann Rheum Dis (in press).2.↵Cronbach LJ.Coefficient alpha and the internal structure of tests.Psychometrika1951; 16:297–333.3.↵McKinley RK, Manku Scott T, Hastings AM, French DP, Baker R.Reliability and validity of a new measure of patient satisfaction with out of hours primary medical care in the United Kingdom: development of a patient questionnaire.BMJ1997; 314:193–8.OpenUrlFREE Full Text4.↵Bosma H, Marmot MG, Hemingway H, Nicholson AC, Brunner E, Stansfield SA.Low job control and risk of coronary heart disease in Whitehall II (prospective cohort) study.BMJ1997; 314:558–65.
Although mental health information on the internet is often of poor quality, relatively little is known about the quality of websites, such as Wikipedia, that involve participatory information sharing. The aim of this paper was to explore the quality of user-contributed mental health-related information on Wikipedia and compare this with centrally controlled information sources.
Content on 10 mental health-related topics was extracted from 14 frequently accessed websites (including Wikipedia) providing information about depression and schizophrenia, Encyclopaedia Britannica, and a psychiatry textbook. The content was rated by experts according to the following criteria: accuracy, up-to-dateness, breadth of coverage, referencing and readability.
Ratings varied significantly between resources according to topic. Across all topics, Wikipedia was the most highly rated in all domains except readability.
The quality of information on depression and schizophrenia on Wikipedia is generally as good as, or better than, that provided by centrally controlled websites, Encyclopaedia Britannica and a psychiatry textbook.
You need a machine to help you
Training as a radiology resident is a complex task. Residents frequently encounter multiple hospital systems, each with unique workflow patterns and heterogenous information systems. We identified an opportunity to ease some of the resulting anxiety and frustration by centralizing high-quality resources using a wiki. In this manuscript, we describe our choice of wiki software, give basic information about hardware requirements, detail steps for configuration, outline information included on the wiki, and present the results of a resident acceptance survey.
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- Ucla Medical Harbor
- Research Center
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- Ri Donaldson
Director, Global Health Program, Department of Emergency Medicine, Harbor-
UCLA Medical Center
RESEARCH AND APPLICATIONS
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The Free Encyclopedia
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27, 2016, 22:37 UTC. Available at: https://en.wikipedia.org/w/index.
php?title=Wiki&oldid=707279650. Accessed May 1, 2015.
org: a collaborative online knowledge platform for oncology professionals
- J L Warner
- A J Cowan
- A C Hall
- Yang Pc Hemonc
Warner JL, Cowan AJ, Hall AC, Yang PC. HemOnc.org: a collaborative online
knowledge platform for oncology professionals. J Oncol Pract.
2015;11(3):e336-e350.
Wiki-based clinical practice guidelines for the management of adult onset sarcoma: a new paradigm in sarcoma evidence
- Neuhaus