Article

Development and usage of wiki-based software for point-of-care emergency medical information

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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.

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... 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]. ...
Preprint
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]. ...
Article
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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. ...
Article
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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.
... 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]. ...
Article
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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. ...
Article
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.
Article
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.
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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.
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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.
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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.
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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.
Article
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.
The Free Encyclopedia Available at: https://en.wikipedia.org/w/index. php?title=Wiki&oldid=707279650
  • Wikipedia Contributors
  • Wiki
  • Wikipedia
Wikipedia contributors. Wiki. Wikipedia, The Free Encyclopedia. February 27, 2016, 22:37 UTC. Available at: https://en.wikipedia.org/w/index. php?title=Wiki&oldid=707279650. Accessed May 1, 2015.
Look Who's Using Wikipedia. Time
  • B Tancer
Tancer B. Look Who's Using Wikipedia. Time. 2007. Available at: http://www.ti me.com/time/business/article/0,8599,1595184,00.html. Accessed May 1, 2015.
Make technical articles understandable. Wikipedia, The Free Encyclopedia Available at: https://en.wikipedia.org
  • Wikipedia Contributors
  • Wikipedia
Wikipedia contributors. Wikipedia:Make technical articles understandable. Wikipedia, The Free Encyclopedia. January 29, 2015, 23:07 UTC. Available at: https://en.wikipedia.org. http://en.wikipedia.org/wiki/Wikipedia:
org: a collaborative online knowledge platform for oncology professionals
  • Jl Warner
  • Aj Cowan
  • Ac 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.
  • Ucla Medical Harbor
  • Research Center
  • And
  • Ri Donaldson
Director, Global Health Program, Department of Emergency Medicine, Harbor- UCLA Medical Center RESEARCH AND APPLICATIONS Donaldson RI, et al. J Am Med Inform Assoc 2016;0:1–6. doi:10.1093/jamia/ocw033, Research and Applications
The Free Encyclopedia
  • Wikipedia Contributors
  • Wiki
  • Wikipedia
Wikipedia contributors. Wiki. Wikipedia, The Free Encyclopedia. February 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