Medicine 2.0

Official proceedings publication of the Medicine 2.0 Congress

2014-10-04

"Medicine 2.0" (ISSN 1923-2195, Medline Abbreviation: Med 2 0) is the official proceedings publication of the Medicine 2.0 Congress (World Congress on Social Media in Health, Medicine, Health, and Biomedical Research), and other events, workshops and tutorials promoted under the Medicine 2.0 label.

Since July 2014, all Medicine 2.0 papers are now in PubMed Central and indexed in PubMed.

Conference organizers interested in promoting a new conference or their existing workshop/tutorial/event series under the Medicine 2.0 label and making it eligible for publication in a Pubmed indexed Proceedings volume, please contact us.

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Journal Description

"Medicine 2.0" (ISSN 1923-2195, Medline Abbreviation: Med 2 0) is the official proceedings publication of the Medicine 2.0 Congress (World Congress on Social Media in Health, Medicine, Health, and Biomedical Research), and other events, workshops and tutorials promoted under the Medicine 2.0 label.

We currently only accept submissions from presenters at Medicine 2.0 conferences and workshops promoted at www.medicine20congress.com. (event organizers interested in promoting their workshop/tutorial/event under the Medicine 2.0 label and making it eligible for publication in a Pubmed indexed Proceedings volume, please contact us).

Presenters at Medicine 2.0 events are eligible to submit short proceedings papers. For details see Online Submissions instructions.

Full-text articles are XML tagged using the NLM-DTD, archived in PubMed Central and indexed in PubMed.

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Recent Articles:

  • Health Information on the Web and Consumers’ Perspectives on Health Professionals’ Responses to Information Exchange

    Authors List:

    Abstract:

    Background: Health information technology, which is sometimes referred to as informaticization of medicine, is changing the extent to which patients become competent producers of their own health by enabling them access to health information anytime and anywhere. Objective: This research provides preliminary information on users' perceptions of the extent to which use of the Internet for health information impacts medical encounters. We specifically explored the following questions: (1) To what extent perceptions of positive or negative changes in medical encounters are associated with sociodemographic background of online health information seekers, and how often the Internet information is discussed with providers? (2) To what extent is there an association between perceived changes in medical encounters and frequency of referring to the Internet during medical encounters? (3) To what extent is there an association between sociodemographic background of online health information users and frequency of discussing of the Internet information with providers? Methods: The data for this study was derived from a national sampling of online health and medical information users who participated in the Study of Health and Medical Information in Cyberspace—Survey of User Perceptions (N=710). This study used a nationally representative online research panel of the US adults maintained by the Knowledge Networks. Analysis of variance (ANOVA), chi-square, and t tests were performed to examine the data. Results: Although Internet sources allow people the opportunity to gather health or medical information, discussion of this information was not a very common activity. It is noteworthy that half of the sample never or rarely discussed health/medical information obtained from Internet sources with health professionals. Chi-square analyses revealed that discussion of online health information with providers were associated with education, income, and marital status. We also found that discussion of the Internet information mostly promotes better physician-patient interactions. Analyses with post-hoc tests identified that perceived changes in medical encounters were associated with age, education, and income. However, 9.1% (64/703) of our respondents strongly agreed that the interactions with their providers have been strained. T test analyses showed that marital status, race, and gender were not significant. Conclusions: Embracing new technologies, and adapting to changing roles and relationships in delivery of medical care are critical to effective delivery of patient-centered care. Health professionals could also guide patients on how to evaluate information and where to access to reliable and accurate information.
  • Employee and Family Assistance Video Counseling Program: A Post Launch Retrospective Comparison With In-Person Counseling Outcomes

    Abstract:

    Background: Access to technologically mediated information and services under the umbrella of mental and physical health has become increasingly available to clients via Internet modalities, according to a recent study. In May 2010, video counseling was added to the counseling services offered through the Employee and Family Assistance Program at Shepell·fgi as a pilot project with a full operational launch in September 2011. Objective: The objective of this study was to conduct a retrospective post launch examination of the video counseling service through an analysis of the reported clinical outcomes of video and in-person counseling modalities. Methods: A chronological sample of 68 video counseling (VC) cases and 68 in-person (IP) cases were collected from a pool of client clinical files closed in 2012. To minimize the variables impacting the study and maintain as much clinical continuity as possible, the IP and the VC clients must have attended clinical sessions with any one of six counselors who provided both the VC and the IP services. The study compared the two counseling modalities along the following data points (see glossary of terms): (1) client demographic profiles (eg, age, gender, whether the sessions involved individuals or conjoint sessions with couples or families, etc), (2) presenting issue, (3) average session hours, (4) client rating of session helpfulness, (5) rates of goal completion, (6) client withdrawal rates, (7) no show and late cancellation rates, and (8) pre/post client self-assessment. Specific to VC, we examined client geographic location. Results: Data analysis demonstrates that the VC and the IP showed a similar representation of presenting issues with nearly identical outcomes for client ratings of session helpfulness, rates of goal completion, pre/post client self-assessment, average session duration, and client geographic location. There were no statistically significant differences in the rates of withdrawal from counseling, no shows, and late cancellations between the VC and the IP counseling. The statistical analysis of the data was done on SPSS statistical software using 2-sample and pairwise comparison t tests at a 95% level of significance. Conclusions: Based on the study, VC and IP show similar outcomes in terms of client rating of session and goal attainment.
  • Transforming Patient Experience: Health Web Science Meets Medicine 2.0

    Abstract:

    Until recently, the Western biomedical paradigm has been effective in delivering health care, however this model is not positioned to tackle complex societal challenges or solve the current problems facing health care and delivery. The future of medicine requires a shift to a patient-centric model and in so doing the Internet has a significant role to play. The disciplines of Health Web Science and Medicine 2.0 are pivotal to this approach. This viewpoint paper argues that these disciplines, together with the field of design, can tackle these challenges. Drawing together ideas from design practice and research, complexity theory, and participatory action research we depict design as an approach that is fundamentally social and linked to concepts of person-centered care. We discuss the role of design, specifically co-design, in understanding the social, psychological, and behavioral dimensions of illness and the implications for the design of future care towards transforming the patient experience. This paper builds on the presentations and subsequent interdisciplinary dialogue that developed from the panel session "Transforming Patient Experience: Health Web Science Meets Web 2.0" at the 2013 Medicine 2.0 conference in London.
  • Analysis of Twitter Users’ Sharing of Official New York Storm Response Messages

    Abstract:

    Background: Twitter is a social network where users read, send, and share snippets of text (“tweets”). Tweets can be disseminated through multiple means; on desktop computers, laptops, and mobile devices, over ethernet, Wi-Fi or cellular networks. This redundancy positions Twitter as a useful tool for disseminating information to the public during emergencies or disasters. Previous research on dissemination of information using Twitter has mostly investigated the characteristics of tweets that are most effective in raising consumer awareness about a new product or event. In particular, they describe characteristics that increase the chance the messages will be shared ("retweeted") by users. In comparison, little has been published on how information from municipal or state government agencies spreads on Twitter during emergency situations. Retweeting these messages is a way to enhance public awareness of potentially important instructions from public officials in a disaster. Objective: The aim of this study is to (1) describe the tweets of select New York State and New York City agencies by public officials surrounding two notable recent winter storms that required a large-scale emergency response, and (2) identify the characteristics of the tweets of public officials that were most disseminated (retweeted). Methods: For one week surrounding Superstorm Sandy (October 2012) and the winter blizzard Nemo (February 2013), we collected (1) tweets from the official accounts for six New York governmental agencies, and (2) all tweets containing the hashtags #sandy (or #nemo) and #nyc. From these data we calculated how many times a tweet was retweeted, controlling for differences in baseline activity in each account. We observed how many hashtags and links each tweet contained. We also calculated the lexical diversity of each tweet, a measure of the range of vocabulary used. Results: During the Sandy storm, 3242 shared (retweeted) messages from public officials were collected. The lexical diversity of official tweets was similar (2.25-2.49) and well below the average for non-official tweets mentioning #sandy and #nyc (3.82). Most official tweets were with substantial retweets including a link for further reading. Of the 448 tweets analyzed from six official city and state Twitter accounts from the Nemo blizzard, 271 were related to the storm, and 174 had actionable information for the public. Actionable storm messages were retweeted approximately 24x per message, compared to 31x per message for general storm information. Conclusions: During two weather emergencies, New York public officials were able to convey storm-related information that was shared widely beyond existing follower bases, potentially improving situational awareness and disaster response. Official Sandy tweets, characterized by a lower lexical diversity score than other city- and Sandy-related tweets, were likely easier to understand, and often linked to further information and resources. Actionable information in the Nemo blizzard, such as specific instructions and cancellation notices, was not shared as often as more general warnings and “fun facts,” suggesting agencies mix important instructions with more general news and trivia, as a way of reaching the broadest audience during a disaster.
  • Embedding a Learning Management System Into an Undergraduate Medical Informatics Course in Saudi Arabia: Lessons Learned

    Abstract:

    Background: Public universities in Saudi Arabia today are making substantial investments in e-learning as part of their educational system, especially in the implementation of learning management systems (LMS). To our knowledge, this is the first study conducted in Saudi Arabia exploring medical students’ experience with an LMS, particularly as part of a medical informatics course. Objective: This study investigates students’ use of various features of the LMS embedded in a recently implemented medical informatics course. Methods: A mixed methodology approach was employed. Survey questionnaires were distributed to all third year medical informatics students at the end of the course. In addition, two focus group sessions were conducted with twelve students. A thematic analysis of the focus group was performed. Results: A total of 265 third year medical student surveys (167/265, 63% male and 98/265, 37% female) were completed and analyzed. Overall, 50.6% (134/265) of the students agreed that the course was well planned and up-to-date, had clearly stated objectives and clear evaluation methods, appropriate course assignment, and that the LMS offered easy navigation. Most of the students rated the course as good/fair overall. In general, females were 10.4% more likely to prefer the LMS, as revealed by higher odd ratios (odds ratio [OR] 1.104, 95% CI 0.86-1.42) compared to males. Survey results showed that students’ use of LMS tools increased after taking the course compared to before taking the course. The full model containing all items were statistically significant (χ225=69.52, P<.001, n=243), indicating that the model was able to distinguish between students who had positive attitudes towards LMS and those who did not. The focus group, however, revealed that the students used social networking for general use rather than learning purposes, but they were using other Internet resources and mobile devices for learning. Male students showed a higher preference for using technology in general to enhance learning activities. Overall, medical student attitudes towards the LMS were generally positive. Students also wanted a reminder and notification tool to help them stay updated with course events. Interestingly, a subset of students had been running a parallel LMS of their own that has features worth exploring and could be integrated with an official LMS in the future. Conclusions: To our knowledge, this was the first time that an LMS was used in a medical informatics course. Students showed interest in adapting various LMS tools to enhance their learning and gained more knowledge through familiarity with the tool. Researching an official LMS also revealed the existence of a parallel student-created LMS. This could allow teacher-led and student-led platforms to be integrated in the future for an enhanced student-centered experience.
  • Participatory Design With Seniors: Design of Future Services and Iterative Refinements of Interactive eHealth Services for Old Citizens

    Abstract:

    Background: There is an increasing social isolation among the elderly today. This will be an even larger issue in the future with growing numbers of elderly and less resources, for example, in terms of economy and staff. Loneliness and social isolation can, however, be addressed in several ways using different interactive eHealth services. Objective: This case study investigated novel eHealth services for the elderly, and their usage of a social interactive device designed especially for them. Methods: In this work, we used an innovative mobile communication device connected to the television (TV), which worked as a remotely controlled large interactive screen. The device was tested by 8 volunteers who visited a senior center. They were between 65 and 80 years of age and lived in their own homes. Throughout the 1.5 year-long project, 7 design workshops were held with the seniors and the staff at the center. During these workshops, demands and preferences regarding existing and new services were gathered. At the end of the project the participants’ experience of the device and of the services was elaborated in 3 workshops to get ideas for improved or new meaningful services. During the data analyses and development process, what seniors thought would be useful in relation to what was feasible was prioritized by the development company. Results: Regarding daily usage, the seniors reported that they mainly used the service for receiving information from the senior center and for communication with other participants in the group or with younger relatives. They also read information about events at the senior center and they liked to perform a weekly sent out workout exercise. Further, they played games such as Memory and Sudoku using the device. The service development focused on three categories of services: cognitive activities, social activities, and physical activities. A cognitive activity service that would be meaningful to develop was a game for practicing working memory. In the social activities category, the seniors wanted different quizzes and multi-player games. For physical activities, the seniors desired more workout exercises and suggestions for guided walking routes. A new category, “information and news”, was suggested since they lacked services like senior-customized global and local news. Conclusions: This study showed the importance of input from a group of seniors when designing new services for elderly citizens. Besides input to interactive eHealth service development for seniors, this study showed the importance of a social context around such work. The seniors were very engaged throughout the project and workshops were frequently visited and the seniors became friends. The high amount of input from the seniors could be explained in terms of social inclusion; they belonged to a group and each member was considered important for the work. The friendly workshop atmosphere facilitated new ideas and redesign of the services.
  • Clinicians’ Assessment of Mobile Monitoring: A Comparative Study in Japan and Spain

    Abstract:

    Background: The gradual but steady shift toward telemedicine during the past decades is a clear response to important health problems that most industrialized countries have been facing. The growing elderly population and changing dietary habits have led to an increase in people with chronic diseases and overall health care expenditures. As more consumers use their mobile device as their preferred information and communication technology (ICT) device, mobile health monitoring has been receiving increasing attention in recent years. Objective: This study examines clinicians’ perception of factors determining mobile health monitoring acceptance in Japan and Spain. The study proposes a causal model consisting of innovation seeking, new ICT attributes (perceived value, time-place flexibility, and compatibility), and usage intention. In addition, cross-country differences are posited for the hypothesized relationships among the proposed constructs. Methods: A questionnaire survey was performed to test our research model and hypotheses. The sample consisted of clinicians from various medical specialties. In total, 471 and 497 usable responses were obtained in Japan and Spain, respectively. Results: In both countries, the collected data fit the model well with all the hypothesized paths among the constructs being supported. Furthermore, the moderating effects of psychic distance were observed in most of the paths. Conclusions: Our study demonstrates the importance of new ICT attributes, namely perceived value, time-place flexibility, and compatibility, in the clinicians' adoption of mobile health monitoring. In particular, our results clearly indicated that perceived medical value and ubiquitous nature of the tool are the two main benefits clinicians are likely to perceive (and appreciate) in both countries. This tendency will be stronger for those with a greater propensity to seek innovation in ICT. In terms of cross-country comparison, the strength of the path from innovation seeking to perceived value was greater in Japan than in Spain. Since the number of clinicians per 10,000 residents is substantially fewer in Japan compared with Spain, clinicians with a greater propensity to seek innovation in ICT may have perceived greater value in using mobile health monitoring to improve remote patient care.
  • eHealth Technology Competencies for Health Professionals Working in Home Care to Support Older Adults to Age in Place: Outcomes of a Two-Day Collaborative...

    Abstract:

    Background: The demand for care is increasing, whereas in the near future the number of people working in professional care will not match with the demand for care. eHealth technology can help to meet the growing demand for care. Despite the apparent positive effects of eHealth technology, there are still barriers to technology adoption related to the absence of a composite set of knowledge and skills among health care professionals regarding the use of eHealth technology. Objective: The objective of this paper is to discuss the competencies required by health care professionals working in home care, with eHealth technologies such as remote telecare and ambient assisted living (AAL), mobile health, and fall detection systems. Methods: A two-day collaborative workshop was undertaken with academics across multiple disciplines with experience in working on funded research regarding the application and development of technologies to support older people. Results: The findings revealed that health care professionals working in home care require a subset of composite skills as well as technology-specific competencies to develop the necessary aptitude in eHealth care. This paper argues that eHealth care technology skills must be instilled in health care professionals to ensure that technologies become integral components of future care delivery, especially to support older adults to age in place. Educating health care professionals with the necessary skill training in eHealth care will improve service delivery and optimise the eHealth care potential to reduce costs by improving efficiency. Moreover, embedding eHealth care competencies within training and education for health care professionals ensures that the benefits of new technologies are realized by casting them in the context of the larger system of care. These care improvements will potentially support the independent living of older persons at home. Conclusions: This paper describes the health care professionals’ competencies and requirements needed for the use of eHealth technologies to support elderly adults to age in place. In addition, this paper underscores the need for further discussion of the changing role of health care professionals working in home care within the context of emerging eHealth care technologies. The findings are of value to local and central government, health care professionals, service delivery organizations, and commissioners of care to use this paper as a framework to conduct and develop competencies for health care professionals working with eHealth technologies.
  • Development of a Questionnaire and Cross-Sectional Survey of Patient eHealth Readiness and eHealth Inequalities

    Authors List:

    Abstract:

    Background: Many speak of the digital divide, but variation in the opportunity of patients to use the Internet for health (patient eHealth readiness) is not a binary difference, rather a distribution influenced by personal capability, provision of services, support, and cost. Digital divisions in health have been addressed by various initiatives, but there was no comprehensive validated measure to know if they are effective that could be used in randomized controlled trials (RCTs) covering both non-Internet-users and the range of Internet-users. Objective: The aim of this study was to develop and validate a self-completed questionnaire and scoring system to assess patient eHealth readiness by examining the spread of scores and eHealth inequalities. The intended use of this questionnaire and scores is in RCTs of interventions aiming to improve patient eHealth readiness and reduce eHealth inequalities. Methods: Based on four factors identified from the literature, a self-completed questionnaire, using a pragmatic combination of factual and attitude questions, was drafted and piloted in three stages. This was followed by a final population-based, cross-sectional household survey of 344 people used to refine the scoring system. Results: The Patient eHealth Readiness Questionnaire (PERQ) includes questions used to calculate four subscores: patients’ perception of (1) provision, (2) their personal ability and confidence, (3) their interpersonal support, and (4) relative costs in using the Internet for health. These were combined into an overall PERQ score (0-9) which could be used in intervention studies. Reduction in standard deviation of the scores represents reduction in eHealth inequalities. Conclusions: PERQ appears acceptable for participants in British studies. The scores produced appear valid and will enable assessment of the effectiveness of interventions to improve patient eHealth readiness and reduce eHealth inequalities. Such methods need continued evolution and redevelopment for other environments. Full documentation and data have been published to allow others to develop the tool further.
  • Validity and Reliability of the eHealth Analysis and Steering Instrument

    Abstract:

    Background: eHealth services can contribute to individuals’ self-management, that is, performing lifestyle-related activities and decision making, to maintain a good health, or to mitigate the effect of an (chronic) illness on their health. But how effective are these services? Conducting a randomized controlled trial (RCT) is the golden standard to answer such a question, but takes extensive time and effort. The eHealth Analysis and Steering Instrument (eASI) offers a quick, but not dirty alternative. The eASI surveys how eHealth services score on 3 dimensions (ie, utility, usability, and content) and 12 underlying categories (ie, insight in health condition, self-management decision making, performance of self-management, involving the social environment, interaction, personalization, persuasion, description of health issue, factors of influence, goal of eHealth service, implementation, and evidence). However, there are no data on its validity and reliability. Objective: The objective of our study was to assess the construct and predictive validity and interrater reliability of the eASI. Methods: We found 16 eHealth services supporting self-management published in the literature, whose effectiveness was evaluated in an RCT and the service itself was available for rating. Participants (N=16) rated these services with the eASI. We analyzed the correlation of eASI items with the underlying three dimensions (construct validity), the correlation between the eASI score and the eHealth services’ effect size observed in the RCT (predictive validity), and the interrater agreement. Results: Three items did not fit with the other items and dimensions and were removed from the eASI; 4 items were replaced from the utility to the content dimension. The interrater reliabilities of the dimensions and the total score were moderate (total, κ=.53, and content, κ=.55) and substantial (utility, κ=.69, and usability, κ=.63). The adjusted eASI explained variance in the eHealth services’ effect sizes (R2=.31, P<.001), as did the dimensions utility (R2=.49, P<.001) and usability (R2=.18, P=.021). Usability explained variance in the effect size on health outcomes (R2=.13, P=.028). Conclusions: After removing 3 items and replacing 4 items to another dimension, the eASI (3 dimensions, 11 categories, and 32 items) has a good construct validity and predictive validity. The eASI scales are moderately to highly reliable. Accordingly, the eASI can predict how effective an eHealth service is in regard to supporting self-management. Due to a small pool of available eHealth services, it is advised to reevaluate the eASI in the future with more services.
  • Acceptance of E-Learning Devices by Dental Students

    Abstract:

    Background: E-Learning programs and their corresponding devices are increasingly employed to educate dental students during their clinical training. Objective: Recent progress made in the development of e-learning software as well as in hardware (computers, tablet PCs, smartphones) caused us to more closely investigate into the habits of dental students in dealing with these learning techniques. Methods: Dental students during their clinical training attended a survey compiled in cooperation with biostatisticians. The questionnaire probands were asked to complete based on previous surveys of similar subjects, allowing single as well as multiple answers. The data, which were obtained with respect to the learning devices students commonly employ, were compared with their internet learning activities. Results: The e-learning devices utilized are of heterogeneous brands. Each student has access to at least one hardware type suitable for e-learning. All students held mobile devices, about 90 percent employed laptops, and about 60 percent possess smartphones. Unexceptional all participants of the survey acknowledged an unlimited internet access. In contrast, only 16 percent of students utilized tablet PCs. A detailed analysis of the survey outcome reveals that an increasing use of mobile devices (tablet PC, smartphone) facilitates internet learning activities while at the same time utilization of computers (desktop, laptop) declines. Conclusions: Dental students overwhelmingly accept e-learning during their clinical training. Students report outstanding preconditions to conduct e-learning as both their access to hardware and to the internet is excellent. Less satisfying is the outcome of our survey regarding the utilization of e-learning programs. Depending of the hardware employed only one-third to barely one-half of students comprise learning programs.
  • The Ligurian Human Immunodeficiency Virus Clinical Network: A Web Tool to Manage Patients With Human Immunodeficiency Virus in Primary Care and Multicenter...

    Abstract:

    Background: In recent years, Highly-Active Anti-Retroviral Therapies (HAARTs) have modified the Human Immunodeficiency Virus (HIV) life-cycle and the disease is now considered chronic. Consequently, a longitudinal and complex follow-up is now required for HIV positive patients during their lifetime. Moreover, patients often encounter various complications due to comorbidities, related to the immunodeficiency state and HAARTs’ side effects. Thus, HIV positive patients are involved in multicenter clinical trials (MCTs) to improve treatments and discover a preventive vaccine. Therefore, physicians require proper instruments to access comprehensive patient data for managing patients during follow-ups, and tools for data collection and analysis in MCTs. Objective: The Ligurian HIV Clinical Network aims to provide physicians with a Web-tool to administrate HIV positive patients’ data within primary-care and to reuse the collected clinical information to perform MCTs in Northern Italy. Methods: The key aspect of the system is a relational database which allows the storage of various types of clinical information (eg, related to HIV, cardiovascular, or hepatic diseases) in multiple formats. The modular design of the database permits a rapid insertion of new parameters without requiring any changes in the database structure. Furthermore, codes from biomedical ontologies controlled vocabularies (“Logical Observation Identifier Names and Codes”, and “International Classification of Diseases 9”) and ontologies (“Systematized Nomenclature of Medicine Clinical Terms”), units and normality ranges used by all partners participating in the project were collected to achieve a complete semantic interoperability. Accordingly, data can be automatically normalized through the z score formula and physicians can extract and correctly compare information with external statistical tools. Moreover, to respect patients’ privacy and legal issues, a local identifier, determined through an HASH cryptography algorithm, is assigned to each patient during the registration process. The database is managed by a user-friendly Web-platform which allows quick access to information during medical examinations and the reusing of the collected data for present and future MCTs. Furthermore, a bidirectional middleware was created in order to import/export information through HL7 messaging. Hence, data can be manually entered by physicians or automatically collected within HL7-compliant Hospital Information systems. Results: Presently, the direct storage of patients’ information from the San Paolo Hospital (Savona, Italy), and San Martino and Galliera hospitals in Genoa is in a test phase. Currently, 8 centers of Infectious Diseases (located in Liguria and Piedmont) are participating in the project and almost 400 HIV positive patients have been recorded in the system. Patient data has been used for primary care and research purposes. Currently, there are 4 on-going MCTs and preliminary results have already been presented at International HIV congresses. Conclusions: The Web-platform allows effective management, sharing and reuse of information within primary care and clinical research. In the future it is planned to share the clinical information from this network with other HL7-compliant workgroups and to extend the platform to other infective diseases (eg, hepatitis).

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