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Slide1 l.jpg

Bristlecones (Pinus longaeva & Pinus aristata)

Grow atop the arid mountains of the Great Basin, from Colorado to California

http://www.photo.net/ca/sierra


Evidence based medicine data source l.jpg
EVIDENCE BASED MEDICINE : Data Source

TUESDAY - January 28, 2003

15.00 – 15.30 Internet surfing 

15.30 – 17.15 Webxercises

17.15 – 17.45 General discussion with prize

17.45 – 18.30 Teacher's state of the art lecture: What do you find on the net ?


Slide3 l.jpg

European Academy for Medicine of AgeingIKB Foundation, Sion, SwitzerlandWhat do you find on the net ?F. R. Herrmann, MD, MPH


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Plan

  • Definitions 1

  • History (hardware & internet) 2

  • What info for who?3

  • Web site design 4

  • Quality of content 5

  • Usage 6

  • THM & Perspectives 7


Definition l.jpg
Definition

The Net is an example of a non-teleological(no specific purpose), self-organizing system that combines human and machine communication, reasoning, and associative capabilities.

The History of the Net. Master's Thesis. School of Communications. Grand Valley State University. Allendale, MI; 1994

http://www.ocean.ic.net/ftp/doc/nethist.html


Www world wide web the web l.jpg
WWW = World Wide Web = The Web

A « boundless » information space

populated by a collection of data objectslinked via a communication protocol

LOWE HL et al. The World Wide Web : A review of an emerging Internet-based Technology for the Distribution of biomedical information. JAMIA 3(1) 1996;1-14.



Last part of a domain name in the united states l.jpg
Last Part of a Domain nameIn the United States

GOV Government affiliated organizationMIL Military

EDU Schools, Universities, HospitalsCOM Commercial organizationsNET Gateway computersORG Ill defined organizations


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Plan

  • Definitions 1

  • History (hardware & internet)

  • What info for who? 3

  • Web site design 4

  • Quality of content 5

  • Usage 6

  • THM & Perspectives 7


Slide10 l.jpg

Sebastian M. Cosmographiae Universalis.

Basel; 1550:338-339.

http://historic-cities.huji.ac.il/central_europe/central_europe.html


History l.jpg
History

-3000Chinese abacus 100Roman abacus

http://www.soroban.com/museum/index_eng.html


History12 l.jpg
History

Leonardo da Vinci 1452-1519

~1500 First drawing of a mechanical calculator

http://www.maxmon.com/1500ad.htm


History13 l.jpg
History

Wilhelm Schickard 1592 - 1635 D

  • First calculator to speed Kepler’s

    astronomicalcomputation

    Blaise Pascal1623 - 1662 F

    1642Pascaline

    To simplytaxes processing

    http://www-groups.dcs.st-and.ac.uk/~history/PictDisplay/Schickard.html

    http://www-groups.dcs.st-and.ac.uk/~history/Mathematicians/

    http://www.maxmon.com/1640ad.htm


History14 l.jpg
History

Joseph-Marie Jacquard1752-1834 F

1800 invent the loom programmed trough punched cardboard

Regularityof silk weaving

Design with more than 8 colors

Job made easier


History15 l.jpg
History

Charles Babbage 1791-1871 UK

1823 Difference Engine through funding from the British Government for calculating and printing mathematical tables by machine

1827 published a table of logarithms from 1 to 108000

1833began work on the Analytical Engine

Precision of numeric tables

http://ei.cs.vt.edu/~history/Zuse.html


History17 l.jpg
History

Herman Hollerith1860-1929USA

1880 Punch cards

1890 U.S. census

1896 Tabulating Machine Co…

1924 ...International Business Machine

Efficiency

Cense faster and less expensive

http://www.history.rochester.edu/steam/hollerith/

http://www.oz.net/~markhow/writing/holl.htm


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History

1907 Lee de Forest 1873-1961 USA

audion = "triode" = "bulb"


History20 l.jpg
History

Alan Turing1912 -1954 UK

1936Concepts of Universal Turing Machine, to solve all algorimical questions

1939Bombe, firstelectromecanical device to decypherencoded messages through the German Enigma

1950« Computing Machinery andIntelligence » in the journal Mind


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History

Konrad Zuse 1910 -1995 D

1935 First idea to construct a "mechanical brain »

1937 Elementary operation is: "Check of two binary digits for equality. Result is a variable with two values, which is once more a binary digit."

1938Z1 : fully mechanical programmable digital computer (test model).

1940 Z2 : first fully functioning electro-mechanical computer of the world.

http://ei.cs.vt.edu/~history/Zuse.html


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The Z1 computer in the living room of Konrad Zuse's parents in 1936 http://www.epemag.com/zuse/Images/fig7b.jpg


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History in 1936

Konrad Zuse 1910-1995 Germany

1941 Z3. First realization of a program control using the binary digits.

1943 Henschel Aircraft Factory : first process control systemfor measuring the wings of airplanes

1945 Z4 Plankalkül(plan calculus), first programming language, a predecessor of the modern algorithmic programming languages

1950 Z4 used at ETH


History24 l.jpg
History in 1936

1945: John von Neumann wrote "First Draft of a Report on the EDVAC" in which he outlined the architecture of a stored-program computer.

Vernon Bush envision Hypertext "As we may think”

1946: ENIAC completed

1947:Transistor : W. Schokley, W Brattain, J. Bardeen. Bell Tel. Lab.

http://www.computerhistory.org/timeline/



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History in 1936

1958: Integratedcircuit by Jack Kilby(TI)

1961: UNIMATE, first industrial robot

1962: P. Baranconceive Internet (Rand Corp)

1963: D.C. Engelbartdescribe Hypertext

1964: P. Baranwrites a proposal in response to the U.S Government’s need for a decentralized communications networkin the event of a nuclear holocaust.

http://www.ti.com/corp/docs/kilbyctr

http://www.isoc.org/internet-history/brief.html

http://www.isoc.org/guest/zakon/Internet/History/HIT.html


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How it works : in 1936 1964 Paul Baran’s specifications

  • The communication network will have:

    • No central authority

    • Ability to work under the worst possible conditions

    • Ability to assume that it is unreliable at all times

    • Ability to transcend it's own unreliability

    • All nodes in network equal in status, having the ability to originate, pass and receive messages

    • Messages divided into discrete packets of data

    • No priority on routing of packets


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Standard communication in 1936

How it works

Arrival

Start


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Internet communication in 1936

How it works

Arrival

Start


History31 l.jpg
History in 1936

1965T.H. Nelson define Hypertext

1967 First Electronic Handheld Calculator

First internal pacemaker (Medtronics)

http://www.isoc.org/internet-history/brief.html

http://www.ti.com/corp/docs/kilbyctr


History32 l.jpg
History in 1936

1968Realization of Arpanet (Advanced Research Project Agency Network)

1970TCP/IP (Transmission ControlProtocol / Internet Protocol)

1971 First Microprocessor (Intel)

1977 Apple II

1981 IBM PC

1989 Tim Berners-LeeWorld Wide Web



History34 l.jpg
History in 1936

1990ARPANET is deactivated

ARCHIE - First Internet search engine to catalogue software programs located at FTP sites on the Internet.

1991GOPHER-Created to catalogue the vast quantities of rawinformation on the Internet into a menu type format.


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History in 1936

1992WWW- created for high energy physics researchers to share information.Over 1M computers connected to theinternet.

1993First browser "MOSAIC" becomes all purpose internet tool for web and Usenet group browsing, and E-mail.

US Whitehouse, United Nations and World Bank join the Internet community.

Bill Clinton first president to receive E-mail at [email protected]

Commercial exclusion lifted on Internet


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History in 1936

1994 First business starts taking orders online.

Law Firm spans the internet with E-mail advertising

1995 Netscape Navigator become most popular WWW browser.

The Internet becomes a commercial success.

Technologies of the Year: WWW, Search engines

Emerging Technologies: Mobile code (JAVA, JAVAscript),

1996 INTERNIC creates new IP addressing format to accomodate shortage of IP addresses. HTML 3.0

Hacks of the Year: US Dept of Justice, CIA, Air Force, UK Labour Party, NASA - US Air Force

Technologies of the Year: Search engines, JAVA, Internet Phone

Emerging Technologies: Virtual environments (VRML), Collaborative tools, Internet appliance (NC)

1997 First Swiss banks propose telebanking

Technologies of the Year: Push, MulticastingEmerging Technologies: Push, Streaming Media


History 1998 l.jpg
History in 1936 1998

Top 10 Domains by Host #: com, net, edu, mil, jp, us, uk ,de, ca, au

Hacks of the Year:

US Dept of Commerce (20 Feb),

New York Times (13 Sep)

China Society for Human Rights Studies (26 Oct),

UNICEF (7 Jan)

Technologies of the Year: E-Commerce, E-Auctions, PortalsEmerging Technologies: E-Trade, XML, Intrusion Detection

http://www.isoc.org/guest/zakon/Internet/History/HIT.html#Sources


History 1999 l.jpg
History in 1936 1999

The first full-service bank available only on the Net, opens for business.

Hacks of the Year: Star Wars, US Senate, Paraguay Gov't, Microsoft (26 Oct), UK Railtrack (31 Dec)

Technologies of the Year: E-Trade, Online Banking, MP3

Emerging Technologies: Net-Cell Phones, Thin Computing, Embedded Computing

Viruses of the Year: Mellisa (March), Explore (June)

http://www.isoc.org/guest/zakon/Internet/History/HIT.html#Sources


History 2000 l.jpg
History in 1936 2000

  • Massive denial of service attack launched against major web sites, including Yahoo, Amazon, and eBay (February)

  • Web size estimates by NEC-RI and Inktomi surpass 1 billion indexable pages

  • The European Commission contracts with a consortium of 30 national research networks for the development of Géant, Europe's new gigabit research network meant to enhance the current capability provided by TEN-155 (6 Nov)

  • Technologies of the Year: ASP, Napster

  • Emerging Technologies: Wireless devices, IPv6

  • Virus of the Year:Love letter (May)

  • Lawsuits of the Year : Napster, DeCSS

  • http://www.isoc.org/guest/zakon/Internet/History/HIT.html#Sources


  • History 2001 l.jpg
    History in 1936 2001

    • First live distributed musical The Technophobe & The Madman -- over Internet2 networks debuts on 20 Feb European Council finalizes an international cybercrime treaty on 22 June and adopts it on 9 November. This is the first treaty addressing criminal offenses committed over the Internet.

    • Afghanistan's Taliban bans Internet access country-wide, including from Government offices, in an attempt to control content (13 Jul)

    • Viruses of the Year:Code Red (Jul), Nimda (Sep), SirCam (Jul), BadTrans (Apr, Nov) E

    • Emerging Technologies: Grid Computing, P2P

  • http://www.isoc.org/guest/zakon/Internet/History/HIT.html#Sources


  • Growth of internet hosts l.jpg
    Growth of Internet hosts in 1936

    http://www.zakon.org/robert/internet/timeline/ - Growth

    Data from M. Lottor / Network Wizards on http://www.nw.com


    Evidence based medicine data source42 l.jpg
    EVIDENCE BASED MEDICINE : Data Source in 1936

    TUESDAY - January 28, 2003

    15.00 – 15.30 Internet surfing 

    15.30 – 17.15 Webxercises

    17.15 – 17.45 General discussion with prize

    17.45 – 18.30 Teacher's state of the art lecture: What do you find on the net ?


    Hands on exercises of web searches l.jpg
    Hands on exercises of Web searches in 1936

    « Webvidence » based medicine:

    Try to find answers to queries thanks to the Web

    Password for questions: webeama


    Evidence based medicine data source44 l.jpg
    EVIDENCE BASED MEDICINE : Data Source in 1936

    TUESDAY - January 28, 2003

    15.00 – 15.30 Internet surfing 

    15.30 – 17.15 Webxercises

    17.15 – 17.45 General discussion with prize

    17.45 – 18.30 Teacher's state of the art lecture: What do you find on the net ?


    Hands on exercises of web searches45 l.jpg
    Hands on exercises of Web searches in 1936

    « Webvidence » based medicine:

    Try to find answers to queries thanks to the Web

    Password for questions: webeama


    Slide46 l.jpg
    Plan in 1936

    • Definitions 1

    • History (hardware & internet) 2

    • What info for who?

    • Web site design 4

    • Quality of content 5

    • Usage 6

    • THM & Perspectives 7


    Scientist researcher l.jpg
    Scientist / Researcher in 1936

    • Databases access

      • genetics (ex)

      • biochemical

      • scientific pictures

      • literature searches & impact factors

      • classifications

    • Grants information

    • On-line Publication

    • Meeting organization (ex)


    Medline nlm the u s national library of medicine l.jpg
    Medline & NLM in 1936 The U.S. National library of medicine

    « The wealth of new medical information issuing from research centers around the world cannot be used to improve our health and cure disease unless it is made available rapidly to the entire health science community. »

    Donald A. B. Lindberg, M.D.

    Director of the NLM


    Browsing the literature and searching for the right article l.jpg
    Browsing the literature and searching for the right article in 1936

    Most of medical current literature searches programs are based on the Medline

    database.


    Papers about internet and a ged in medline l.jpg
    Papers about in 1936 Internet and agedin Medline

    Zelingher J. Medicine on the Internet, summer 96. Editorial. MD Computing 1996 13(4) 295-7


    Clinicians l.jpg
    Clinicians in 1936

    • Databases access

      • literature searches

      • drug information

      • Cochran

    • Online journals

    • Professional information

    • Public Health information

    • Congress registration


    Clinicians64 l.jpg
    Clinicians in 1936

    • Faster communications between hospitals labs and GP

    • Continuous Medical Education

    • Telemedicine


    Is nasalflu an intranasal influenza vaccine safe l.jpg
    Is Nasalflu (an in 1936 intranasal influenza vaccine) safe?

    Medline

    Key words Hits

    Nasalflu 2

    Intranasal influenza vaccine 442

    Intranasal influenza vaccine & YEAR =2002 25

    Intranasal influenza vaccine & YEAR =2001 46

    Intranasal influenza vaccine & Safety 50


    Is nasalflu an intranasal influenza vaccine safe66 l.jpg
    Is Nasalflu (an in 1936 intranasal influenza vaccine) safe?

    Glueck R. Intranasal immunization against influenza. J Aerosol Med 2002; 15:221-8.

    Glueck R. Review of intranasal influenza vaccine. Adv Drug Deliv Rev 2001; 51:203-11.

    .

    “Out of four serious adverse events seen during the clinical development, only one was thought to be remotely related to the test vaccine.Nasalflu, developed by the Swiss Serum and Vaccine Institute, is a novel, highly immunogenic and safe influenza subunit vaccine which is easily administered as a nasal spray.”


    Is nasalflu an intranasal influenza vaccine safe67 l.jpg
    Is Nasalflu (an in 1936 intranasal influenza vaccine) safe?

    http://www.bernabiotech.com/news/archive/article/20010914_01.html

    Berna Biotech AG decides not to market Nasalflu during the current flu season. Scientific investigations to clarify the situation. Bern, 14 September 2001

    The market leader in the Swiss flu vaccine business, Berna Biotech AG, has decided not to sell its nasal flu vaccine Nasalflu until the situation has been completely clarified regarding a possible connection between Nasalflu and temporary facial paralysis (facialis parese). This clarification includes a case control study of the Swiss market last winter. In addition, a large-scale clinical study of the tolerability of Nasalflu is to be conducted in several European countries.


    Is nasalflu an intranasal influenza vaccine safe68 l.jpg
    Is Nasalflu (an in 1936 intranasal influenza vaccine) safe?

    http://www.bernabiotech.com/news/archive/article/20020606_01.html

    Berne, June 6, 2002

    Clinical investigation of the association between Nasalflu and Bell's palsy discontinued after preliminary data fail to exclude a possible association. Berna Biotech to accelerate development of a 2nd generation nasal flu vaccine product


    G eriatric student l.jpg
    ( in 1936 Geriatric) student

    • Universities

    • Teaching hospitals

    • Learning programs

    • Multimedia case management


    Classical vectors of medical teaching l.jpg
    Classical vectors of medical teaching in 1936

    • Reading

      (textbooks, medical journal, case reports)

    • Lectures (conferences, tutorials, seminars)

    • Hands-on experiments

      (physiology, microbiology, biochemistry...)

    • Clinical rounds

    • Bed-side teaching

    • Case based learning


    Computers provide l.jpg
    Computers provide in 1936

    • Databases

    • Search engines

    • Expert system

    • Case base learning

    • Simulators


    Slide72 l.jpg
    WWW in 1936

    Bring all of the above plus :

    • Hypertexted multimedia

      • Text, Picture, Sound, Animation, Movie

    • Real time Updates

    • Interactivity


    Web specific teaching tools l.jpg
    Web-specific teaching tools in 1936

    • On-line electronics journals

    • Pictures' library

    • Virtual hospitals

    • Self-learning modules

    • Teleteaching (CME)


    E lderly citizen l.jpg
    ( in 1936 Elderly) citizen

    • Patients groups and societies

    • Health care providers

    • Telemedicine

    • Nursing homes

    • Hospitals

    • News

    • Banking

    • Advertising / shopping

    • State administration


    C itizen l.jpg
    C in 1936 itizen

    • Patients groups and societies

    • Health care providers

    • Nursing homes / Hospitals

    • News

    • Banking

    • Advertising / shopping / gaming

    • State administration

    • Communications (phone, webcam teleconference)


    Slide76 l.jpg

    An Elderly Couple in 1936 1510-28Oil on vellum(?) mounted on wood, 46 x 67 cmNational Gallery, London

    By Jan GOSSAERT (called Mabuse)

    http://www.kfki.hu/~arthp/html/g/gossaert/2/


    Qualitician l.jpg
    Qualitician in 1936

    • Databases access

      • Drugs

      • Sentinel events

    • Quality related institutions / services


    I nstitution l.jpg
    I in 1936 nstitution

    • Provide information to

      • patients

      • visitors

      • research volunteers

      • future employee

    • Communicate data on quality management

      • Statistics

      • Actions taken


    Slide79 l.jpg
    Plan in 1936

    • Definitions 1

    • History (hardware & internet) 2

    • What info for who? 3

    • Web site design

    • Quality of content 5

    • Usage 6

    • THM & Perspectives 7


    Slide80 l.jpg

    Nielsen J.  in 1936 "Top ten mistakes" in web design revisited three years later (1999).

    • Using frames

    • Gratuitous use of bleeding edge technology

    • Scrolling text, marquees, and constantly running animations

    • Complex URLs

    • Orphan pages

    • Long scrolling pages

    • Lack of navigation support

    • Non­standard link colours

    • Outdated information

    • Long download times

      Purcell GP et al. BMJ 2002; 324: 557-8.

      www.useit.com/alertbox/990502.html


    Slide81 l.jpg
    Plan in 1936

    • Definitions 1

    • History 2

    • What info for who? 3

    • Web site design 4

    • Quality of content

    • Usage 6

    • THM & Perspectives 7

    http://bmj.com/content/vol324/issue7337/cover.shtml


    Quality of healthcare information on the net who is hon l.jpg

    Quality of Healthcare Information in 1936 On the Net: Who is HON?

    François Herrmann, Celia Boyer, Melanie Provost

    European Forum on Population Ageing Research

    Workshop on Technology Advances - E-Health And E-Care.

    WHO regional Copenhagen, Denmark - 24th October 2002

    October 24th, 2002



    Hon s mission l.jpg

    Search guide in 1936

    HON code of Conduct

    HON’s services

    World-Wide online Reliable Advice to Patients and INdividuals

    HON’s mission

    • to guide healthcare consumers and providers on the World Wide Web to sound, reliable medical information and expertise

    • to contribute to better, more accessible and cost-effective health care

    HON’s research studies


    Honcode to improve the quality of medical and health web sites l.jpg
    HONcode: to improve the quality of in 1936 medical and health Web sites

    Pioneer since 1996

    Concise code of conduct:

    8 principles

    In 21 languages

    • 3300+ sites accredited

    • From the most important to smallest organisation

      • MEDLINEplus

      • Cancer Information Service (CIS) of the National Cancer Institute (NCI)

      • Healthfinder.gov

      • InteliHealth

    Accreditation system

    Valid methodology

    - In service since 1997

    - Formal application process

    - Manual verification process

    - Active verification process

    - 5 to 10 requests per day

    - Monitoring


    Slide86 l.jpg

    Health On the Net in 1936 Code of Conduct principles

    .

    Principle 1:Authority

    To be given by medically/health trained and qualified professionals.

    Principle 2:Complementarity

    The information provided is designed to support, not to replace.

    Principle 3:Confidentiality

    Confidentiality of data relating to individual patients and visitors.


    Health on the net code of conduct principles l.jpg
    Health On the Net in 1936 Code of Conduct principles

    .

    Principle 4:Attribution

    To be supported by clear references to source data

    Principle 5:Justifiability

    Any claims relating to the benefits/performance of a specific treatment will be supported by appropriate evidence in the manner outlined in Principle 4.


    Health on the net code of conduct principles88 l.jpg
    Health On the Net in 1936 Code of Conduct principles

    .

    Principle 6:Transparency of authorship

    To provide information in the clearest possible manner and provide contact addresses for visitors.

    Principle 7:Transparency of sponsorship

    Support for this website will be clearly identified, including commercial and non-commercial organisations.

    Principle 8:Honesty in advertising & editorial policy

    The advertising policy adopted by the website owners will be displayed on the site.


    Honcode compliant site geriatrics l.jpg

    Web site Personalised Identification number in 1936

    After revision by the HON

    team the site status demonstrates

    compliance with the HONcode.

    We subscribe to the HONcode principles

    HONcode Compliant site - Geriatrics



    Improve literacy access to quality information wrapin l.jpg
    Improve literacy & access to quality information: in 1936 WRAPIN

    With a more efficient sharing of reliable and trustworthy knowledge, WRAPIN will help the citizen/individual to make appropriate judgments on medical information

    • Two mains directions:

      • the efficient and intelligent search of information

      • the assertion of content trustworthiness

    World-Wide online Reliable Advice to Patients and Individuals

    EU project: IST-2001-33260 – Two years


    European commission to publish a code of practice for websites l.jpg
    European Commission to publish a code of practice for websites

    European Commission to publish a code of practice for websites Rory Watson, Brussels AMIA email news 01. 2003

    • Transparency and honesty - by providing full details of the provider of the site, its objective (including any commercial considerations),target audience, and sources of funding

    • Authority - by sourcing and dating all information displayed and providing full credentials of individuals and institutions


    European commission to publish a code of practice for websites93 l.jpg
    European Commission to publish a code of practice for websites

    • Privacy and confidentiality - with the requirement for an opt-in of any personal data

    • Currency - by regularly updating the site's contents

    • Accountability - through user feedback and a clear statement of editorial policy

    • Accessibility -with attention to general searchability and usability.


    Slide94 l.jpg
    Rating Health Information on the lnternet. Navigating to Knowledge or to Babel?A.R. Jadad; A. Gagliardi. JAMA 1998;279:611-614

    Objectives:

    • Identify instruments used to rate Web sites providing health information on the lnternet

    • Rate criteria used bythem

    • Establish the degree of validation of the instruments,


    Slide95 l.jpg

    Rating Health Information on the lnternet. Navigating to Knowledge or to Babel?A.R. Jadad; A. Gagliardi. JAMA 1998;279:611-614

    Data Synthesis

    • 47 rating instruments identified

    • 14 provided a description of the criteria used to produce the ratings

    • 5 provided instructions for their use.

    • None of the instruments identified provided information on the interobserver reliability and construct validity of the measurements.


    Slide96 l.jpg
    Rating Health Information on the lnternet. Navigating to Knowledge or to Babel?A.R. Jadad; A. Gagliardi. JAMA 1998;279:611-614

    Conclusions

    Manyincompletely developed instruments to evaluate health information exist on the lnternet.

    It is unclear, whether they :

    • should exist in the first place,

    • measure what they claim to measure or

    • lead to more good than harm.


    Slide97 l.jpg
    How do consumers search for and appraise health information on the world wide web? Eysenbach G et al. BMJ 2002;324:573-7.

    Users explore only the first fewlinks on general search engines

    Consumers assess the credibilityof a site by looking for source, professional design, and other criteria

    In practice, users do not check the “about us” sections of websites, try to find out who authors or owners of the site are, or read disclaimers or disclosure statements

    Very few internet users later remember from which websites they retrieved information or who stood behind the sites


    Slide98 l.jpg
    Users explore only the first few on the world wide web? links on general search enginesEysenbach G et al. BMJ 2002;324:573-7.

    17 Subjects

    271 Queries

    763 Web pages


    Slide99 l.jpg
    Plan on the world wide web?

    • Definitions 1

    • History (hardware & internet) 2

    • What info for who? 3

    • Web site design 4

    • Quality of content 5

    • Usage

    • Perspectives 7


    Slide101 l.jpg

    Source of information on flu vaccination on the world wide web? N = 2300 and 1500 residents of the State of Geneva aged 65+


    Interest in and usage of e health applications and services by older people l.jpg

    Interest in and usage of e-health applications and services by older people

    Karl A. Stroetmann PhD, Lutz Kubitschke MA, Tobias Huesing MA,Veli N. Stroetmann MD PhD

    Institute for Communications- and Technology Research

    Bonn / Germany

    www.seniorwatch.de

    EF on Population Ageing Research, Copenhagen, Oct. 24, 2002


    Slide103 l.jpg

    Methodology by older people

    • 9,661 respondents aged 50+

    • EU-wide random sample(geographically & socio-demographically stratified)

    • CATI-based telephone interviews during summer 2001

    • Data weighting according to country size and representative for the EU


    Slide104 l.jpg

    Demography of by older peopleOPS Respondents

    Household size:

    one person......................22%

    two persons....................48%

    three persons+...............30%

    Age:

    50-59.............36%

    60-69.............31%

    70-79.............25%

    80+..................8%

    Type of area:

    rural/ small town............65%

    urban/ suburban............35%


    Slide105 l.jpg

    Access to and usage of general purpose ICT applications by older people

    Access:

    Standard TV..................98%

    Cable TV........................30%

    Digital TV.......................13%

    Mobile Phone................48%

    PC...................................36%

    Notebook/Laptop............5%

    Internet...........................22%

    Usage:

    Teletext (on TV)............45%

    Mobile Phone................42%

    Computer......................27%

    Internet..........................17%


    Slide106 l.jpg

    North South Gradient re internet usage by older people

    • shares of internet users among the European older population vary considerably across Europe

    • there is a clear north-south gradient regarding regular internet usage


    Slide107 l.jpg

    ICT involvement - Older by older peoplepopulationcovers broad spectrum

    • The old age beginners

    • Computerusers

    • less skills / using computers less often

    • The experienced frontrunners

    • Computerusers

    • Advanced skills or frequently using computers ( > once a week)

    • ICT involvement is a compound indicator which takes account of attitudes, skills and usage data

    • Users are different as to their usage intensity, non-users differ re their openness to become involved.

    • The older population covers the whole variety of ICT involvement

    • About one third are heavily at risk of being left behind.

    • The technologically open-minded

    • Non-users, but

    • Keen on learning or wishing to improve computer skills

    • The digitally challenged

    • Non-users

    • Neither keen on learning nor wishing to improve computer skills


    Slide108 l.jpg

    ICT involvement as a matter of age and education by older people

    • 72% of those aged 50-59 and 21+ years old when finishing their education (i.e. university degree and equivalent) are experienced frontrunners

    • But none of those aged 80+ and leaving school <14 years old are experienced frontrunners.


    Functional restrictions a challenge for user friendly and assistive technologies l.jpg
    Functional restrictions - a challenge for user-friendly and assistive technologies

    Prevalence of functional restrictions

    as % of older population

    • Functional restrictions often hinder full scale IST uptake

    • Vision restrictions are most prevalent

    • 21 % suffer from either severe vision, hearing or tactile restrictions

    • 64 % suffer from either severe or light vision, hearing or tactile restrictions

    12%

    5%

    Some

    difficulty

    26%

    27%

    Vision

    Serious

    Hearing

    restrictions

    11%

    10%

    19%

    Dexterity

    Either

    restrictions


    Slide110 l.jpg

    Conclusions assistive technologies

    • Vast market for e-Health applications and services(e.g.40% of the European population of 50+ age (49 m people!) are computer users, 27% have advanced skills and use a PC at least once a week)

    • Market will grow substantially as those presently still in work retire ( e.g. when those currently 50 to 65 retire)

    • Diverse access media need to be explored(e.g. TV sets, mobile phones, teletext)

    • User interfaces to allow access for disabled people(e.g. hearing, visual, dexterity)

    • Policy measures required to avoid a "Medical Divide“(e.g. awareness, skills, accessibility)



    Are elderly interested in e health l.jpg

    Are Elderly interested in e-Health? assistive technologies

    François Herrmann*, Celia Boyer, Melanie Provost

    European Forum on Population Ageing Research

    Workshop on Technology Advances - E-Health And E-Care.

    WHO regional Copenhagen, Denmark - 24th October 2002

    October 24th, 2002


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    Exploratory Analysis of Older Respondents assistive technologiesto the 8th HON Online Survey

    Are Elderly interested in e-Health?


    Method l.jpg
    Method assistive technologies

    • Voluntary Online Self-administered Questionnaire

      • English and French

      • 3 Sections, 31 questions

      • Posted between March and June 2002

    • Target respondents: Patients and Health Professionals

      • Section II specific to each group

    • Announced on HON’s and collaborator’s web sites (100)

    • Email invitation sent to 16,000 HON newsletter members


    Results 8 th hon s survey l.jpg

    Total Sample assistive technologies

    N=2586

    Age Groups:

    <=19: 0.9%

    20-29: 11.8%

    30-39: 19.0%

    40-49: 29.3%

    50-59: 24.0%

    60-69: 9.3%

    70-79: 3.1%

    >=80: 0.6%

    Results – 8th HON’s Survey

    13%


    Focus on older population l.jpg
    Focus on Older Population assistive technologies

    • Sub-sample: 336 respondents, 60 yrs of age and older

    • Demographics:

      • 61% male, 39% female

      • 57% USA, 16% Europe, 6% Canada

      • 72% EN, 7% SP, 6%IT, 3% FR

    • Type of respondents:

      • Patients: 65%

      • Medical professionals: 35%


    Internet experience of elder l.jpg
    Internet Experience of Elder assistive technologies

    All types

    • 35% have been using the Internet for 1-3 years

    • 47% for more than 4 yrs

    • Daily use:

      • 78% from home

      • 56% from work

    • 80% searched medical literature

    • 62% searched disease description


    Elderly patients and e health l.jpg

    N=217 (65%) assistive technologies

    21% buy via on-line pharmacy

    Rx 70%

    OTC 30%

    48% have used online medical consultation services

    70% occasionally

    30% frequently

    23% engaged email correspondance with their own health care providers

    Elderly Patients and e-Health

    e-health… « e » as in elderly?!


    Elderly their most important concerns l.jpg

    Concern about the medical Internet? assistive technologies

    55% advantage the certified sites

    Elderly: their Most Important Concerns

    #1 Accuracy of information 23%

    #2 Trustworthiness 15%

    How to reduce these issue?

    Certification and/or accreditation:

    62.5% of elderly respondents agree


    Do patients understand the information l.jpg
    Do patients understand the information? assistive technologies

    • Up to 71% seek info from medical professional sites or sections dedicated to medical professionals (n=217)

    • If the elderly do not understand the information they read (n=150):

      • 28% ask their physician

      • 87% do alternative searches


    How do elderly search the internet l.jpg

    Search Engines assistive technologiesNo

    General Medical Opinion

    N % % %

    Health Professionals11624 6111

    Patients 217 36 3325

    Total 336 32 4321

    How do Elderly search the Internet?


    Slide122 l.jpg
    Plan assistive technologies

    • Definitions 1

    • History (hardware & internet) 2

    • What info for who? 3

    • Web site design 4

    • Quality of content 5

    • Usage 6

    • Perspectives


    Thm 1 internet s a dvantages l.jpg
    THM 1 : Internet’s assistive technologiesadvantages

    Fast distribution at low cost of

    • Teaching materials

    • News

    • Information

    • Software

    • Database access

      For the impaired and the elderly :

    • Zoom and reading functions


    Thm 2 internet s inconvenients l.jpg
    THM 2 : Internet’s assistive technologiesInconvenients

    • Can still be slow : “World Wide Wait”

    • Quality of information not always guarantied

    • Still needs a minimum of computer literacy

    • Has a cost

    • Lost in a maze

    • Incomplete

    • Advertising

    • Dead URL, site

    • Confidentiality


    Thm 3 3 d s of evaluating health information l.jpg
    THM 3 : assistive technologies3 D's of evaluating health information

    • Dates — Health information is dynamic. Look for the most recent information you can find. Reputable Web sites include a date for each article they post.

    • Documentation — Check for the source. Notice whether articles refer to published medical research. Look peer reviews. Turn to sites created by major medical centers, national organizations, universities or government agencies. Be wary of commercial sites.

    • Double-checking — Visit several health sites and compare the information.

      Mayo Clinic HealthQuest, November 1999

      http://www.mayohealth.org/mayo/9801/htm/judging.htm


    Thm 4 search strategies l.jpg
    THM 4 : Search strategies assistive technologies

    • Focus: write your search question

    • Search engines: use not only general one but also Medical search engine & portals

    • Hits: looknot only for the first hits

    • Boolean operators—AND OR NOT narrow your searches

    • Bookmarks: keep track of good (and bad) sites

    • Save (or print) results: WEB sites can be down temporarilly or for ever, their URL changed…


    Perspectives l.jpg
    Perspectives assistive technologies

    Wireless

    Wearable

    Safer

    Faster

    Easier

    Power lines

    Grid computing


    Slide128 l.jpg
    Grid assistive technologies

    • Collection of distributed computing resources available over an area network that appear as one large virtual computing system.

    • The vision is to create virtual dynamic organizations through secure, coordinated resource-sharing among individuals, institutions and resources.

    • Grid computing spans locations, organizations, machine architectures and software boundaries to provide unlimited power and collaboration.

      http://www-1.ibm.com/grid/grid_what_is.shtml


    Slide129 l.jpg

    Braun and Hogenberg assistive technologies. Civitates Orbis Terrarum

    1572: map I-37.

    http://historic-cities.huji.ac.il/switzerland/sion/maps/braun_hogenberg_I_37.html


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