Internet and Neurophysiological Resources.

Dr. Renzo Bassi
Legnago, Verona
       

Introduction.

THE MAIN QUESTIONS ARE:

  • How can WEB pages help neurophysiologists as members of the medical profession ?
  • Can web browsing become an essential tool for our daily work ?
  • Which are the best neurophysiological resources ?

World wide networking via the Internet promises to revolutionize the way information is shared and consumed. Developers of medical resources on the Internet recognize possibilities in utilizing world-wide networking abilities to enhance communication and knowledge between and within the many areas of the medical professions. As recently as in 1996, it was questionable whether the Internet would ever have practical uses for healthcare.

In recent months Internet has seen a boom in its use as a medical resource: in a short time medical information retrieval, specialists updating, contact with collegues and lastly the relationship with the patient will rely heavily on this technology.

On-line medical resources continue to get better and computer programs used to access them are easier to use than ever before. As more and more health care providers get on-line and learn to use the Internet, the value of being on-line will increase. However, the benefits may not be immediately apparent because the medical professions still have growing pains to go through in the networked world and should not expect an easy transition.

   Useful plug-ins and helpers on board
  • An audio plug-in
  • A zip-unzip program
  • Acrobat Reader for PDF format
  • Shockwave (by Macromedia)

WEB pages are excellent tools for communication, postgraduate teaching, for educational purposes and personal introduction .

Multimedial features of WEB have a great impact.

SONY Research 1996 : IMPACT ON MASS MEDIA
  • Sound                                  (Radio)            18 %
  • Sight                                    (Newspapers) 19 %
  • Sound + Sight                      (TV)                 52 %
  • Sound + Sight +Interaction (WEB)             75 %

The availability of such a cheap, universal, easily upgradable and direct media , enables the scientific community, medical world, neuroscientists and clinical neurophysiologists to use a range of invaluable professional resources.

Neurophysiologists too have benefited by becoming users and diffusers of news.

Since the www started a few years ago we have soon seen the development of general medical sites, followed by neuroscience sites and more recently exclusive neurophysiological sites.

Neurophysiologists can boast a neurophysiologist as webmaster-editor of the most visited neuroscience site (www.neuroguide.com) ; complete textbooks online ; one of the most important journals in this field (Muscle & Nerve) is freely online in full text since ’97; medical electrophysiological machines can be networked with Internet

E-mail

E-mail is the most widely used technology ; it is a new style of informal, fast, lean, cheap and cross border communication, both for professional exchanges and remote consultation.

A standard e-mail account allows the user to send a typewritten message to any other person or to any number of people in the world with e-mail accounts. In recent years, e-mail programs have grown more complex and now allow users to package computer files such as word processor documents, voice messages, images, and programs as "attachments" to the e-mail. Voice messaging is a particularly eye catching application of e-mail because it could mean being able to receive "phone messages" in your e-mail account in the future. For the time being, e-mail predominantly remains a simple text only environment.

In conclusion e-mail is an exciting opportunity even though there are, generally speaking, no specific applications in our field.

E-mail : true international Internet

  • WEB WEEK forecasting for 97: 2,7 trillion mail messages
  • Outstanding for discussion and addressing individual problems
  • Often the only internet tool to keep in touch with the developing world

Electronic literature.

Aesthetics, portability, and other given weaknesses aside, electronic literature has many qualities that makes it useful especially to research oriented populations. One very useful feature of electronic text is that it is keyword searchable, meaning that the reader can automatically jump to every place in a document where a key word or phrase appears. Keyword searching affords the user the ultimate subject index. Another useful quality is the ease of replicating electronic information which can be cut and pasted or cheaply duplicated from source without loss of quality.

Where are we headed ?

" We think that eventually all journal articles and books will become a network of interlinked databases, continually updated with new articles linked to other articles..."

Pieter Bolman (president of Academic Press)
in Online Access Is Profoundly Changing Scientific Publishing
(C. Cruzan Morton, The Scientist, 3/31/97)

Also because digital information can be directly transmitted over a network, patient data, research findings, radiographs, data analysis, insurance reports, etc. are much more easily and efficiently exchanged between parties than through faxes or having documents brutalized by mail delivery services.

Where are we headed ?

  Future of the medical journals

  • Electronic-only (no print
  • counterpart)
  • Articles independent of journals?
  • Multiple views of same paper
  • Interactivity
  • Multimedia
  • Links to data

The medical Internet now features on-line journals (both exclusive and electronic versions of print editions), electronic textbooks, news services, continuing education classes, clinical practice guidelines, patient education handouts, drug databases, discussion forums, image and video clip libraries, and interactive programs among other things.

Internet has not caused the death of biomedical journals , but has supplied another important tool for professional upgrading.

A unique and important advantage of electronic publishing is the enhanced ability to entertain discussions and invite commentary. Authors of pre-prints could especially benefit from the ability to present drafts to a scientific community for commentary . Some researchers even put up their works in progress and invite discussion from their colleagues around the world. With the multimedia nature of the WWW, presentations of studies are free to contain sound and video--something that print media will never accomplish.


On-Line MEDLINE and Other Medical Database

Amid all the warnings of questionable information on-line, there's the healthcare professional's old friend MEDLINE. Numerous options, Web based or otherwise, exist to access the MEDLINE database on-line. Some MEDLINE searches are free and some are available for a fee. Free MEDLINE searches became popular in 1996 and numerous web sites now host a free MEDLINE search. Free searches were first seen as advertising gimmicks to draw traffic to web sites, but since the National Library of Medicine (NLM) in the US has begun offering PubMed and Internet Grateful Med for free, signs indicate that MEDLINE (free or for a fee) through the Internet can be a legitimate asset. In general, the free MEDLINE services are inferior counterparts to the fee based services. A systematic evaluation of a number of free MEDLINE services performed by one group in June of 1997 found that some services may have databases that are as much as seven weeks behind the better ones. Currency of the database is really a minor issue. More important is that there are sharp an important differences between the interfaces (search engines) created by each service to retrieve relevant items from the MEDLINE database.

The search engine programmed for each site to access the MEDLINE database is the most important piece of a MEDLINE search and unfortunately also the most inconsistent. Some engines will perform "fuzzy logic" searches and find related articles. Some have advanced search options that allow fine tuning of a search to increase the relevance of returned materials. Some are simple to use but so stripped down that they're no longer useful for purposeful research. A few such as the NLH's Internet Grateful Med and Ovid) even cross reference terms with the MeSH database, a "subject thesaurus" that can be used to find information related to the search term.

Useful chemical, biochemical and pharmaceutical database can be readily accessed on the web.


Electronic Textbooks and Reference Guides

A growing number of medical texts are either available on-line or in electronic form in CD-ROM or other formats. One such textbook that is available on CD-ROM and on-line is the popular Merck Manual. Another on-line textbook is Wheeless'Textbook of Orthopedics, which few if any electronic textbooks currently on-line can match in content and user friendliness. One look at Wheeless' work is an insight into how the Internet can benefit clinical medicine.

As neurophysiologists we can enjoy two textbooks of Electromyography, the first by the scandinavian group ( Falck, Stalberg, Korpinen), the other by J. Jabre.

Another very useful online textbook of neuromuscular (but also spinal and cerebellar) diseases is edited by the group of A. Pestronk from the Washington University of S. Louis - Missouri


Quality of WEB pages

With the popularity of the Internet growing on the healthcare front and concerns over the quality of

information, there have been calls to develop standardized methods to evaluate the quality of on-line

resources.

"Reliability of Health Information for the
public on the WEB : fever in children ….."
British Medical Journal June 97
(Impicciatore et alii)

Conclusion: "only a few web sites provide complete and accurate information .
There is an urgent need to check Internet resources for accuracy, completeness, consistency."

 

Quality of information is not only a concern over misinformation, but also to spare healthcare professionals the time and frustration of scanning through a promising looking site with completely sound, but useless information. To address the issue, an assessment tool for a medical website's quality can be based on the following criteria:

  • Credibility (source of info, context, currency, relevance, and peer review)
  • Content (accuracy, hierarchy of evidence, original sources, disclaimer, omissions)
  • Disclosure (purpose of site, profiling of the site's purpose and background)
  • Links (selection, architecture, content, back linkages and description)
  • Design (accessibility, organization, internal search engine)
  • Interactivity (mechanism for feedback, chat rooms, tailoring of info)
  • Caveats (alert information)

Questions to Ask About the Evaluation of Web Pages

Criterion #1: AUTHORITY

  • Is it clear who is sponsoring the page?
  • Is there a link to a page describing the purpose of the sponsoring organization?
  • Is there a way of verifying the legitimacy of the page's sponsor? That is, is there a phone number or postal address to contact for more information? (Simply an email address is not enough).
  • Is it clear who wrote the material and are the author's qualifications for writing on this topic clearly stated?
  • If the material is protected by copyright, is the name of the copyright holder given

Criterion #2: ACCURACY

  • Are the sources for any factual information clearly listed so they can be verified in another
  • source?
  • Is the information free of grammatical, spelling, and other typographical errors? (These kinds of errors not only indicate a lack of quality control, but can actually produce inaccuracies in information).
  • Is it clear who has the ultimate responsibility for the accuracy of the content of the material?
  • If there are charts and/or graphs containing statistical data, are the charts and/or graphs clearly labeled and easy to read?

Criterion #3: OBJECTIVITY

  • Is the information provided as a public service?
  • Is the information free of advertising?
  • If there is any advertising on the page, is it clearly differentiated from the informational content?

Criterion #4: CURRENCY

  • Are there dates on the page to indicate:
           a - When the page was written?
           b - When the page was first placed on the Web?
           c - When the page was last revised?
  • Are there any other indications that the material is kept current?
  • If material is presented in graphs and/or charts, is it clearly stated when the data was gathered?
  • If the information is published in different editions, is it clearly labeled what edition the page is from?

Criterion #5: COVERAGE

  • Is there an indication that the page has been completed, and is not still under construction?
  • If there is a print equivalent to the Web page, is there a clear indication of whether the entire work is available on the Web or only parts of it?
  • If the material is from a work which is out of copyright (as is often the case with a dictionary or thesaurus) has there been an effort to update the material to make it more current?

Sites of neurophysiological interest

Now we can rely on many sites that contain interesting resources or links for the neurophysiologist : they are catching up as regards coverage and reliabililty.

To date probably the most complete indexing neurophysiological site is : Clinical Neurophysiology (on the Internet) mantained by Baoqing Wang (PA - U.S.A.)

The web page "Clinical Neurophysiology on the Internet" is intended to be a comprehensive index for internet resources on clinical neurophysiology. It includes general information, basic and applied neurophysiological knowledge and techniques, diagnostic assessments, and intraoperative monitoring, and lists of institutions and organizations, conferences, journals, and internet discussion mailing lists and news groups, etc. The web page is at http://cn.home.ml.org.

An overview of neurophysiological resources on the WWW permits us to draw the following conclusions: American domination, fair European presence and the lack of a omnicomprehensive European site.

    What are the main features of an ideal clinical neurophysiological site?
  • Contains original documents
  • Related links to field departments, organisations and associations
  • Well organized, ranked and commented links
  • Deals with diseases common to neurophysiological practice, in particular epilepsy neuromuscular disesases, movement disorders, carpal tunnel syndrome, etc.
  • Contains complete neurophysiological techniques
  • Pharmaceutical, equipments and diagnostic resources
  • Congresses, mailing list, newsgroups, journals
  • Editorial board certification and references; feedback
  • Neurophysiological software
  • Special certification (HON ?, neuro WEB ring?)

 

A European neurophysiological supersite ? Good Rules
  • Help communication within the European countries
  • Reflect need of a specific community
  • Use of an appropriate language
  • Deals with specific problems
  • Will rely on several personal (and group) contributions
  • Parallel with teleneurophysiologic project

Who is to be the leading staff?

Does the European community of neurophysiologists need a specific web site and

if so, should the European Chapters of IFCN be responsible for developing such a site?


Continuing Medical Education (CME) on the Internet.

Especially in northamerican countries, a growing number of universities are offering CME credits on the Internet. This presents several advantages. In many instances, CME credits are necessary for physicians to renew their licenses. However, even though these courses may be available at various society meetings, not all physicians can afford the time or the distance (or cost) to attend these meetings. The Internet provides a convenient and up to date means to obtain these credits at very low cost. Further, these courses, being sponsored by the same universities which give them at meetings, are just as good and written by the same experts. When these credits are not necessary for licensing purposes, physicians from underserved rural areas or remote parts of the world may use them just to get updated in their specialty. CME courses are usually prepared by authorities in the field, regularly updated and presented in an appealing fashion. A list of relevant questions are given at the end to test the physician's knowledge of the subject after reading the material. The reader is then graded for their comprehension. If they successfully complete the "course" a certificate is mailed to them attesting to their successful completion in exchange for a minimum fee.


Consideration upon web site build up and grown.

Is it very important that the creation and mantainance of a specialistic site could be based on a well planned project with good financial resources, not only on voluntary contribution and the use of spare time. Many organisations, hospital and medical center websites are still developed by people working "in their spare time," and there needs to be an "official" organizational commitment (financial and/or personnel) to creating these resources.

A sponsorship may be considered , but we must not depend entirely on this.

WEB ring gathering good neurophysiological resources might be a way to improve the quality and the search of pages that are suitable for neurophysiologists.

Every country’s specialistic site should have an english version and follow common rules.

We need have urged individual medical specialty societies to develop electronic information standards for their own respective practice areas. Future labeling of sites that meet

established standards has been suggested as one solution to the problem, but the flexible nature of the web makes handing out seals of approval also a complicated issue. First of all, with the size and chaotic nature of the Internet, putting out a universally recognized seal of approval would be virtually impossible. Also, because the Web is a dynamic environment, what is considered "good" today, may not be so tomorrow. This can be best illustrated by the great number of outdated websites that still display "best of the Net" type of awards from over a year past.


An anthology of sites for an on line connection.

http://k2.scl.cwru.edu/~bqw/neuro

http://www.bio.unipd.it/~telethon/muscle1.html

http://enmc.spc.ox.ac.uk/default.html

http://www.aaem.net/

http://www2.interscience.wiley.com/issn/0148-639X/

http://www.aan.com/xls/sections/cnp/cnphome.htm

http://www.neuro.wustl.edu/neuromuscular/

http://www.users.cloud9.net/~thorpy/

http://www.neurofys.uu.se/

http://www.tut.fi/~korpinen/EMG.htm

http://www.teleEMG.com/EMGhpg/Default.html

http://www.aapmr.org/

http://www.efa.org/indexf.htm

http://www.erg.ion.ucl.ac.uk/NSEhome/open.html

http://www.neuro.wustl.edu/epilepsy/

http://www.med.univ-rennes1.fr/bfe/carte.htm

http://www.ncbi.nlm.nih.gov/Omim/

http://www.neuroguide.com/

http://www.mic.ki.se/Neuro.html

http://www.medmatrix.org/SPages/Neurology.asp

http://www2.mf.uni-lj.si/~ECCN98/ECCN98.htm

http://www.ec-ifcn.org/

http://www.hon.ch/

http://www.webmedlit.com/topics/CNSLit.html

Clinical Neurophysiology on the Internet

Muscular Pathology ( Padua )

European Neuromuscular Center

American A. Electrodiagnostic Medicine

Muscle & Nerve (full text)

Neurophysiologic Section of A.A.N.

Neuromuscular Department of WUSTL

Sleep Medicine (indexing site)

Neurophysiologic Department - Uppsala

Emg textbook (Falck Stalberg Korpinen)

Emg textbook (J. Jabre)

American A. Physical Medicine Rehab.

Epilepsy Foundation of America

National Society for Epilepsy – U.K.

Epilepsy Department of WUSTL

Bureau Francais Des Epilepsie

Online Mendelian Inheritance in Man

Neurosciences on the Internet

Karolinska Institute - Neurosciences index

Medical Matrix- Neurosciences pages

ECCN 98 in Ljubljana

European Chapter of IFCN

Health on Net Foundation (Geneve)

Neurologic literature review (Webmedlit)

 


 

Presentato al: 9th European Congress of Clinical Neurophysiology. Lubiana, Slovenia, 3-7 giugno 1998.
Advanced Course on Internet anf Information Technology.

Pubblicazione su "E-Neuro":  Luglio 1999
Corrispondenza con gli Autori: renzobassi@indicemedico.it

www.seiemg.it

Prodotti per

Neurofisiologia