Selbsthilfe und Beratung im Internet

The quality of German - language patient decision aids for oncological patients on the internet

BACKGROUND

Previous studies have already shown that decision aids are a suitable tool for patient decision-making. The aim of this work is to conduct an online search for freely available, German-language patient decision aids (PDAs) for cancer patients, followed by an assessment of their quality. For this purpose, a rating tool that is as manageable as possible was developed on the basis of already existing quality criteria.

METHODS

A simulated patient online search was conducted via the four most frequently used search engines in Germany. A quality assessment tool was created utilizing international and national guidelines, with a focus on practicality and manageability. Subsequently, the identified PDAs were rated by 4 raters based on the rating tool.

RESULTS

The number of German-language oncology PDAs is low (n = 22 of 200 URLs) with limited variability regarding rare cancers. Most originate from non-profit organizations. The overall quality is low, as indicated by an average of 57.52% of the maximum evaluation points of the developed quality assessment tool. Reference values used to assess quality were related to e.g. support/effectiveness, adaptation, layout, etc. No qualitative differences were found regarding different publishers. Quality differed between PDAs of different length, with longer PDAs achieving better results.

CONCLUSION

Overall, the supply and quality of German-language PDAs is not satisfactory. The assessment tool created in this study provides a solid, but more manageable basis, for developing and identifying high-quality PDAs.

PRACTICE IMPLICATIONS

PDAs should be increasingly used by physicians in practice. For this, a quick qualitative assessment of PDAs in everyday life must be possible. Future research has to investigate especially the aspect of the length of a PDA in more detail.

[Medical ID and emergency apps: A useful tool in emergency situations or a waste of time?]

Hintergrund

Um in Notfallsituationen eine effektive Versorgung des Patienten zu gewährleisten, sind Informationen über Vorerkrankungen und bisherige Medikamenteneinnahme essenziell. Daher haben Smartphonehersteller entsprechende Anwendungssoftware (App) entwickelt, auf die im Notfall zugegriffen werden kann, um jene Informationen zu erhalten. Ziel der Studie war es herauszufinden, ob Notfall-Apps von Smartphoneinhabern aktiv genutzt werden und ob diese in Notfallsituationen von den behandelnden Notärzten eingesehen werden.

Methode

Zur Datenerhebung wurde eine anonymisierte Umfrage über das Nutzungsverhalten der Notfall-Apps bei verunfallten Patienten der unfallchirurgischen Ambulanz eines universitären Maximalversorgers über einen Zeitraum von 3 Monaten durchgeführt. Parallel fand eine Befragung von Notärzten verschiedener Standorte zu ihren beruflichen Erfahrungen mit den Apps statt.

Ergebnisse

Insgesamt wurden 192 Patienten und 103 Notärzte befragt. Die Notfall-Apps waren 45 % (n = 79) der Befragten nicht bekannt; nur bei 10 % (n = 19) der Befragten war die App mit Daten hinterlegt. Weiterhin zeigte sich, dass insgesamt 21 % (n = 41) der Personen einen Notizzettel mit Vorerkrankungen und Medikamenten bei sich trugen. Von den Befragten Ärzten gaben 42 % (n = 44) an, schon einmal von der App gehört zu haben; nur 6 % (n = 5) durchsuchten jedoch routinemäßig bei nichtansprechbaren Patienten das Smartphone. Erfolgreich genutzt wurde die App bisher nur von 14 % der Ärzte (n = 14).

Schlussfolgerung

Aufgrund der geringen Bekanntheit erscheint es in zeitkritischen Situationen nicht empfehlenswert, das Smartphone der Patienten nach Notfall-Apps zu durchsuchen. Bei Patienten über 55 ist es zurzeit erfolgsversprechender, die Brieftasche nach Informationen zu Vorerkrankungen zu kontrollieren.

[Compliance of osteoporosis patients with additional specific osteoporosis-training course]

BACKGROUND

In the present study patients with an osteoporotic fracture were examined in order to determine how many patients decided to continue their therapy as outpatients having taken part in osteoporosis training at the Dr. Becker Rhein-Sieg Clinic.

PATIENTS AND METHODS

Patients who had previously suffered an osteoporotic fracture and thereafter received inpatient rehabilitation were selected for the study. Patients (n = 95) who had taken part in inpatient rehabilitation after an osteoporotic fracture were approached either via telephone or mail and were then followed up after 6 and 12 months with regard to their adherence to the treatment.

RESULTS

From a total of 95 patients, after 6 months 82 % (n = 78) were contacted successfully and included in the study. 68 out of 78 patients (72 %) had continued their medication. After 1 year 76 % of patients (n = 72) were successfully contacted once. Here, 62 % of patients (n = 59) had continued their medication under medical supervision. In the 1‑year follow-up period there were eight cases of falls, and one of these resulted in a peripheral fracture, which was treated conservatively.

CONCLUSION

Osteoporosis-specific information and osteoporosis training of patients after osteoporotic fracture are important tools to improve the motivation and compliance of patients. One possibility to realize this is osteoporosis-specific training with video presentations and individual care and education of the patients within outpatient or inpatient rehabilitation.

A mapping analytic approach to trace development of multidisciplinary research field

Purpose

– This paper aims to provide clear domain knowledge and recent progresses on electronic healthcare (e-healthcare).

Design/methodology/approach

– In this paper, the authors use citation analysis to describe the trends of study on e-health with the help of CiteSpace II, a software for visualizing citation-based analysis. By analyzing the 2,752 publications and their citation data in ISI database, the authors proposed renewable figures and tables on ranking critical people, institutes, keywords and journals. Through the most influential articles given by CiteSpace, the authors can grasp the main direction in e-health researches. Furthermore, the authors analyzed the literature at e-health literacy as a case, to better understand the development of research viewpoints.

Findings

– Through the analysis, the authors found that e-health is a multi-disciplinary research field and the major research about it has changed. During the early stage, health information quality on the Internet dominates. Gradually, the role of information technology (IT) becomes more important. The authors also found that some researchers, recently, have proposed the effects of IT on e-health literacy which can then improve the ability to use health information on the Internet.

Research limitations/implications

– This paper has some research limitations, such as using an ISI database with most English publications. The future research may be conducted for collecting local publications data in China. It also has some implications. Based on the results, the authors claimed that IT may significantly improve people’s healthcare variance, e.g. e-health literacy. It is necessary to build new IT-based healthcare theories.

Practical implications

– This paper also has some practical implications. Practitioners and institute may easily come to know which are the hot topics, top institutes and tendencies in the e-healthcare field.

Social implications

– This paper may help practitioners to find common interests with other institutions and societies.

Originality/value

– This paper reported the status and trend of research in this field visually, and the result will help researchers to do more in-depth research in the future.

Screening Internet forum participants for depression symptoms by assembling and enhancing multiple NLP methods

Depression is a disease that can dramatically lower quality of life. Symptoms of depression can range from temporary sadness to suicide. Embarrassment, shyness, and the stigma of depression are some of the factors preventing people from getting help for their problems. Contemporary social media technologies like Internet forums or micro-blogs give people the opportunity to talk about their feelings in a confidential anonymous environment. However, many participants in such networks may not recognize the severity of their depression and their need for professional help. Our approach is to develop a method that detects symptoms of depression in free text, such as posts in Internet forums, chat rooms and the like. This could help people appreciate the significance of their depression and realize they need to seek help. In this work Natural Language Processing methods are used to break the textual information into its grammatical units. Further analysis involves detection of depression symptoms and their frequency with the help of words known as indicators of depression and their synonyms. Finally, similar to common paper-based depression scales, e.g., the CES-D, that information is incorporated into a single depression score. In this evaluation study, our depressive mood detection system, DepreSD (Depression Symptom Detection), had an average precision of 0.84 (range 0.72-1.0 depending on the specific measure) and an average F measure of 0.79 (range 0.72-0.9).

Cyber-support: an analysis of online self-help forums (online self-help forums in bipolar disorder)

BACKGROUND

The Internet is becoming increasingly important in psychiatry and psychotherapy.

AIMS

The objective of this study was to evaluate if and how online self-help forums are used by patients with bipolar disorders, their relatives and treating professionals.

METHODS

A total of 2400 postings in two online forums were analysed qualitatively and quantitatively.

RESULTS

"Disclosure", "friendship" and "online-group cohesion" were the main self-help mechanisms. The topics most discussed were "social network", "symptoms of the illness" and "medication". Factor analyses revealed three factors concerning self-help mechanisms: "group cohesion", "emotional support" and "exchange of information", as well as three factors concerning fields of interest: "illness-related aspects", "social aspects" and "financial and legal issues".

CONCLUSION

We infer that the main interest in participating in online forums for patients with bipolar disorders and their relatives is to share emotions and to discuss their daily struggles with the illness. Our study also reveals that social networking is very important for patients coping with bipolar disorders. Psycho-educative programmes should focus on those aspects.

The use of conversation analysis to study social accessibility of an online support group on eating disorders

We conducted a conversation analysis of 21 threads initiated by newcomers of an online support group (OSG) on eating disorders, to examine the discursive process of entering such a group. The analysis revealed three important issues. First, many newcomers articulate that the step to join the group is extremely difficult. Second, a presentation of the self in terms of a diagnosis works as a legitimization for joining the forum. The data suggest that participants who do not fulfil the conditions for such a legitimization do not join the forum. Third, the option of acquiring a serious symptom as a solution to the legitimization problem is offered by one of the regular members. Hence, the newcomers’ discourse reveals issues relevant to the accessibility for undiagnosed sufferers. We discuss these findings theoretically as a phenomenon of self-presentation in relation to community norms. The analysis generates the hypothesis that newcomers are confronted with implicit norms regarding membership legitimacy that they should obey in their self-presentation, although they may not be ready yet to actually do so. OSGs should find strategies to facilitate various possibilities for newcomers to present themselves to the group while becoming a member.

Empowering processes and outcomes of participation in online support groups for patients with breast cancer, arthritis, or fibromyalgia

Ever since the rise of online support groups it has been presumed that there is an empowering effect from patients' participating in these groups, despite a lack of evidence to back up this assumption. In this study we explored if, and in which ways, patients feel empowered by participation. Additionally, we studied which empowering and disempowering processes occur as a result of taking part in these groups. To accomplish this aim, we interviewed 32 participants of online support groups. This analysis revealed the following empowering processes: exchanging information, encountering emotional support, finding recognition, sharing experiences, helping others, and amusement. Disempowering processes were mentioned far less often. Empowering outcomes mentioned were being better informed; feeling confident in the relationship with their physician, their treatment, and their social environment; improved acceptance of the disease; increased optimism and control; enhanced self-esteem and social well-being; and collective action. This article demonstrates that participation in online support groups can make a valuable contribution to the emergence of empowered patients.

Eating disorders and the Internet: cure and curse

OBJECTIVE

The role of culture and the mass-media in relation to eating disorders (EDs) is widely acknowledged, and the Internet has become an important part of this over the last few years. The aim of this report is to suggest the general features and potential clinical implications of "pro-Ana" websites and those concerning the treatment of EDs.

METHOD

We conducted a Google search using the key words "anorexia nervosa (AN) and treatment", "AN and psychotherapy", "AN and pharmacotherapy", and then "pro-anorexia", "pro-ana sites", "thinspiration" and "anorexicnation".

RESULTS

The first group of queries gave respectively 546,000, 212,000 and 39,100 results; the second 257,000, 18,600, 14,200 and 577. Forty-seven of 100 randomly selected pro-ana websites were thoroughly visited.

CONCLUSIONS

Internet websites may increase the accessibility of treatments but also strengthen some of the core psychopathological and symptomatological issues of AN, such as asceticism, competition, purging behaviours and obsession for control. Greater attention should be paid to the health policy of countries in which pro-ana websites flourish, and the clinical implications of the websites themselves.

[Aspects of rehabilitation in HIV and AIDS]

Medical treatment of HIV infection has changed dramatically since 1997. The uncontrollable threat became a chronic disease. On the other hand, many HIV-infected people suffer from high psychological distress and multiple physical complaints. Interaction in HIV prevention could transform into psychological counseling. Counselors should initiate rehabilitation measures and occupational reintegration by utilizing all legal possibilities for handicapped people. Patients and physicians, psychologists and social workers as well as self-help groups should initiate successful reintegration into the workforce and daily life; this could positively influence compliance behavior.