Carlos Rizo

Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions

Abstract Objective To compile and evaluate the evidence on the effects on health and social outcomes of computer based peer to peer communities and electronic self support groups, used by people to discuss health related issues remotely. Design and data sources Analysis of studies identified from Medline, Embase, CINAHL, PsycINFO, Evidence Based Medicine Reviews, Electronics and Communications Abstracts, Computer and Information Systems Abstracts, ERIC, LISA, ProQuest Digital Dissertations, Web of Science. Selection of studies We searched for before and after studies, interrupted time series, cohort studies, or studies with control groups; evaluating health or social outcomes of virtual peer to peer communities, either as stand alone interventions or in the context of more complex systems with peer to peer components. Main outcome measures Peer to peer interventions and co-interventions studied, general characteristics of studies, outcome measures used, and study results. Results 45 publications describing 38 distinct studies met our inclusion criteria: 20 randomised trials, three meta-analyses of n of 1 trials, three non-randomised controlled trials, one cohort study, and 11 before and after studies. Only six of these evaluated “pure” peer to peer communities, and one had a factorial design with a “peer to peer only” arm, whereas 31 studies evaluated complex interventions, which often included psychoeducational programmes or one to one communication with healthcare professionals, making it impossible to attribute intervention effects to the peer to peer community component. The outcomes measured most often were depression and social support measures; most studies did not show an effect. We found no evidence to support concerns over virtual communities harming people. Conclusions No robust evidence exists of consumer led peer to peer communities, partly because most peer to peer communities have been evaluated only in conjunction with more complex interventions or involvement with health professionals. Given the abundance of unmoderated peer to peer groups on the internet, research is required to evaluate under which conditions and for whom electronic support groups are effective and how effectiveness in delivering social support electronically can be maximised.

What's a good doctor and how do you make one? Doctors should be good companions for people.

Editor—Imagine waking tomorrow to find a magic lamp by your bed, and the genie tells you that there is only one wish left. You decide to devote it to making good doctors. What kind of people would these good doctors be? We ask this question often among ourselves—a doctor embarking on his career, an active researcher approaching his peak, and a retired clinician needing geriatric care. We sometimes ask other people too. Despite the disparate vantage points, the wish lists are amazingly similar. We all want doctors who will: Respect people, healthy or ill, regardless of who they are Support patients and their loved ones when and where they are needed Promote health as well as treat disease Embrace the power of information and communication technologies to support people with the best available information, while respecting their individual values and preferences Always ask courteous questions, let people talk, and listen to them carefully Give unbiased advice, let people participate actively in all decisions related to their health and health care, assess each situation carefully, and help whatever the situation Use evidence as a tool, not as a determinant of practice; humbly accept death as an important part of life; and help people make the best possible arrangements when death is close Work cooperatively with other members of the healthcare team Be proactive advocates for their patients, mentors for other health professionals, and ready to learn from others, regardless of their age, role, or status Finally, we want doctors to have a balanced life and to care for themselves and their families as well as for others. In sum, we want doctors to be happy and healthy, caring and competent, and good travel companions for people through the journey we call life. Unfortunately, we do not have a magic lamp, and there is no genie. We must use our own skills and endeavours to make the good doctors we want and need. It is an awesome responsibility.

Internet use by end‐stage renal disease patients

Information on the prevalence and predictors of use of the Internet by patients can be applied to the design and promotion of healthcare Internet technologies. To our knowledge, few studies on Internet use by end‐stage renal disease (ESRD) patients have been reported. The objectives of this study are to ascertain the prevalence and predictors of Internet use by ESRD patients among different dialysis modalities. A questionnaire surveying Internet use was delivered in person to 199 conventional hemodialysis patients (57 returned), and mailed to 170 peritoneal dialysis (PD) patients (42 returned), and 65 nocturnal home hemodialysis (NHD) patients (43 returned). Of the respondents, most (58%) have used the Internet to find information on their health condition. The strong majority (76%) of these patients have easy access to the Internet. A higher proportion of NHD patients (86%) used the Internet compared with the PD patients (60%) (p=0.02). Internet use was found to be more prevalent with younger (p<0.001), more educated (p=0.001), and Canadian‐born patients (p=0.005). The high prevalence of Internet use and easy access to the Internet by ESRD patients suggest that future Internet information and communication systems for healthcare management in ESRD will likely be well adopted by this patient population.

Measuring symptom response to pharmacological interventions in patients with COPD: a review of instruments used in clinical trials.

SUMMARY Objectives: To identify and evaluate the instruments used to measure the effect of pharmacological intervention on symptoms of chronic obstructive pulmonary disease (COPD) in clinical trials. Design: An extensive literature search was conducted for articles published in English in a peer-reviewed journal from 1995 to March 2002 which described a randomised controlled clinical trial measuring symptoms of COPD in response to pharmacological interventions. Patients: Patients with any severity of COPD. Interventions: Any pharmacological intervention for treatment of COPD. Measurements and results: A total of 43 eligible articles were identified. The individual symptoms most frequently measured were dyspnoea/breathlessness, chest tightness or discomfort and exacerbations. There was considerable variability in the methods, terminology and symptom measurement instruments used. The most widely used instruments for measuring dyspnoea were the Borg scale, the Baseline Dyspnoea Index and the Transitional Dyspnoea Index. None of the instruments used had published evidence of rigorous psychometric testing. Conclusions: Numerous methods have been employed to assess the symptoms of COPD in clinical trials, making it difficult to compare the results of different trials. No single measurement instrument predominates, and none of the measures identified in the review have undergone rigorous psychometric testing in this patient population. There is a clear need for a fully developed and validated tool for measuring the effects of therapeutic interventions on symptoms in COPD in clinical trials.

Development of the Internet Clinical Communication Centre: A Patient Centered Application for Prostate Cancer Follow-up

This project aims to provide selected follow-up healthcare services via Internet technologies. A usercentered approach and qualitative method of inquiry taken in the development of a prostate cancer Internet Clinical Communication Centre (iC3) to provide clinicians and patients access to portions of the electronic health record, illustrates the critical importance of security, privacy, and the patient-provider relationship.