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Internet sources are becoming increasingly important in seeking health information, such that they may have a significant effect on health care decisions and outcomes. Hence, given the wide range of different sources of Web-based health information (WHI) from different organizations and individuals, it is important to understand how information seekers evaluate and select the sources that they use, and more specifically, how they assess their credibility and trustworthiness. The aim of this study was to review empirical studies on trust and credibility in the use of WHI. The article seeks to present a profile of the research conducted on trust and credibility in WHI seeking, to identify the factors that impact judgments of trustworthiness and credibility, and to explore the role of demographic factors affecting trust formation. On this basis, it aimed to identify the gaps in current knowledge and to propose an agenda for future research. A systematic literature review was conducted. Searches were conducted using a variety of combinations of the terms WHI, trust, credibility, and their variants in four multi-disciplinary and four health-oriented databases. Articles selected were published in English from 2000 onwards; this process generated 3827 unique records. After the application of the exclusion criteria, 73 were analyzed fully. Interest in this topic has persisted over the last 15 years, with articles being published in medicine, social science, and computer science and originating mostly from the United States and the United Kingdom. Documents in the final dataset fell into 3 categories: (1) those using trust or credibility as a dependent variable, (2) those using trust or credibility as an independent variable, and (3) studies of the demographic factors that influence the role of trust or credibility in WHI seeking. There is a consensus that website design, clear layout, interactive features, and the authority of the owner have a positive effect on trust or credibility, whereas advertising has a negative effect. With regard to content features, authority of the author, ease of use, and content have a positive effect on trust or credibility formation. Demographic factors influencing trust formation are age, gender, and perceived health status. There is considerable scope for further research. This includes increased clarity of the interaction between the variables associated with health information seeking, increased consistency on the measurement of trust and credibility, a greater focus on specific WHI sources, and enhanced understanding of the impact of demographic variables on trust and credibility judgments.

Hospital-based health promotion resources to assist pregnant women in adopting a healthy lifestyle and optimizing gestational weight gain are important, but with limited effects. Increasingly, women are using mobile apps to access health information during the antenatal period. The aims of the study were to investigate app-usage by Chinese women during pregnancy and to gain a better understanding of their views and attitudes toward apps containing health information. A mixed methods study design was applied. Study participants were recruited from 2 maternity hospitals in Shanghai, China, between March and July 2018. A self-administered Web-based survey was conducted with 535 pregnant Chinese women on their sources of health information and reasons for using apps during pregnancy. A total of 4 semistructured focus groups were also conducted with the pregnant women (n=28). The use of pregnancy-related apps and the internet was common among the respondents. Almost half of the women had used pregnancy-related apps. Specifically, the use of apps for health information declined as pregnancy progressed from 70% (35/50) in the first trimester to 41.3% (143/346) in the third trimester. The main reason for using an app was to monitor fetal development (436/535, 81.5%), followed by learning about nutrition and recording diet in pregnancy (140/535, 26.2%). The women found that the apps were useful and convenient and can support lifestyle modifications during pregnancy. However, some apps also contained misinformation or incorrect information that could cause anxiety as reported by the participants. Many women expressed the need for developing an app containing evidence-based, well-informed, and tailored health information to support them during pregnancy. The study suggests that apps were widely used by many Chinese women during pregnancy to monitor fetal development, to obtain diet and physical activity information, and to track their body changes. The women highly appreciated the evidence-based information, expert opinions, and tailored advice available on apps. Smartphone apps have the potential to deliver health information for pregnant women.

Although studies report that more than 90% of pregnant women utilize digital sources to supplement their maternal healthcare, little is known about the kinds of information that women seek from their peers during pregnancy. To date, most research has used self-report measures to elucidate how and why women to turn to digital sources during pregnancy. However, given that these measures may differ from actual utilization of online health information, it is important to analyze the online content pregnant women generate. To apply machine learning methods to analyze online pregnancy forums, to better understand how women seek information from a community of online peers during pregnancy. Data from seven WhatToExpect.com \"birth club\" forums (September 2018; January-June 2018) were scraped. Forum posts were collected for a one-year period, which included three trimesters and three months postpartum. Only initial posts from each thread were analyzed (n = 262,238). Automatic natural language processing (NLP) methods captured 50 discussed topics, which were annotated by two independent coders and grouped categorically. The largest topic categories were maternal health (45%), baby-related topics (29%), and people/relationships (10%). While pain was a popular topic all throughout pregnancy, individual topics that were dominant by trimester included miscarriage (first trimester), labor (third trimester), and baby sleeping routine (postpartum period). More than just emotional or peer support, pregnant women turn to online forums to discuss their health. Dominant topics, such as labor and miscarriage, suggest unmet informational needs in these domains. With misinformation becoming a growing public health concern, more attention must be directed toward peer-exchange outlets.

Background Suicide is within the top 10 causes of death in the US and rates have increased over 30% in the last two decades. Identifying suicide risk in healthcare settings has become a national priority and predicting risk using statistical models has emerged as a promising approach to achieve this. Numerous previously published models drawing on information in hospital records, insurance claims, or single healthcare networks perform reasonably well. With recent federal mandates established to develop health information exchanges (HIEs) that include patient information from both diverse healthcare settings and multiple healthcare networks, it is imperative to determine whether this newer data source offers an opportunity to model suicide risk with robust yet largely non-curated, real-world patient information. We examined the characteristics and performance of suicide risk models developed from a HIE, the Kansas Health Information Network. Methods In this retrospective cohort study, utilizing HIE data between 2012 and 2017, we developed predictive models of suicide attempts in 18–64 year old Kansas residents. Predictors included patient age, gender, and medical diagnosis codes. We evaluated model performance metrics, predictor importance, and characteristics of patients accurately labeled as high risk. Results A total of 501,595 18–64 year old Kansas residents were included in the study, with a suicide attempt rate of 0.4% ( n  = 1,914). Our best model had an average area under the ROC curve (AUROC) of 0.82 that was typical of published models (AUROCs = 0.73–0.85), and predictors of suicide attempts included diagnosis codes found in other published models but also reflected the diversity of clinical settings contributing to the HIE. Conclusions Real-world data from the diverse clinical settings captured in an HIE may provide unprecedented opportunities to predict suicidal behavior.

The diffusion of health information exchange (HIE), in which clinical data are electronically linked to patients in many different care settings, is a top priority for policy makers. To drive HIE, community and state efforts were federally funded to broadly engage providers in exchanging data in ways that improved patient care. To assess the current landscape, we conducted a national survey of community and state HIE efforts soon after federal funding ended. We found 106 operational HIE efforts that, as a group, engaged more than one-third of all US providers in 2014. However, the number of operational HIE efforts is down from 119 in 2012, representing the first decline observed since the tracking of these efforts began in 2006. Only half of operational efforts reported being financially viable, and all efforts reported a variety of barriers to continuation. These findings raise important questions about whether the current vision for HIE efforts will allow for the broad exchange of clinical data, or whether alternative approaches would be more successful.

The exchange and use of health information can help healthcare professionals and policymakers make informed decisions on ways of improving patient and population health. Many low-and middle-income countries (LMICs) have however failed to embrace the approaches and technologies to facilitate health information exchange (HIE). We sought to understand the barriers and facilitators to the implementation and adoption of HIE in LMICs. Two reviewers independently searched 11 academic databases for published and on-going qualitative, quantitative and mixed-method studies and searched for unpublished work through the Google search engine. The searches covered the period from January 1990 to July 2014 and were not restricted by language. Eligible studies were independently, critically appraised and then thematically analysed. The searches yielded 5461 citations after de-duplication of results. Of these, 56 articles, three conference abstracts and four technical reports met the inclusion criteria. The lack of importance given to data in decision making, corruption and insecurity, lack of training and poor infrastructure were considered to be major challenges to implementing HIE, but strong leadership and clear policy direction coupled with the financial support to acquire essential technology, improve the communication network, and provide training for staff all helped to promote implementation. The body of work also highlighted how implementers of HIE needed to take into account local needs to ensure that stakeholders saw HIE as relevant and advantageous. HIE interventions implemented through leapfrog technologies such as telehealth/telemedicine and mHealth in Brazil, Kenya, and South Africa, provided successful examples of exchanging health information in LMICs despite limited resources and capability. It is important that implementation of HIE is aligned with national priorities and local needs. L’échange et l’utilisation des informations sur la santé peuvent aider les professionnels de la santé et les décideurs à prendre des décisions éclairées sur les moyens d’améliorer la santé des patients et des populations. De nombreux pays à revenu faible ou intermédiare (PRF-PRI) n’ont cependant pas su adopter les approches et technologies permettant de faciliter l’échange des informations sur la santé (HIE). Nous avons cherché à comprendre les éléments qui entravent ou facilitent la mise en œuvre et l’adoption des informations sur la santé dans les PRF-PRI. Deux auteurs ont indépendamment parcouru 11 bases de données universitaires à la recherche d’études qualitatives, quantitatives et mixtes, publiées et en cours de publication; ils sont également allés à la recherche de travaux non publiés par le biais du moteur de recherche Google. Les recherches portaient sur la période de janvier 1990 à juillet 2014 et n’étaient pas restreintes à une seule langue. Les études retenues ont été évaluées, puis analysées par thème de manière indépendante et critique. Les recherches ont donné 5461 citations après déduplication des résultats. Parmi celles-ci, 56 articles, trois résumés de conférences et quatre rapports techniques répondaient aux critères d’inclusion. Le peu d’importance accordée aux données dans la prise de décision, la corruption et l’insécurité, le manque de formation et l’insuffisance des infrastructures sont apparus comme des défis majeurs à la mise en œuvre des informations sur la santé; mais par contre des éléments comme un solide leadership et une orientation politique claire assortis d’un soutien financier permettant d’acquérir la technologie essentielle, d’améliorer le réseau de communication et de former le personnel, contribuent tous à la promotion de la mise en œuvre. L’ensemble des travaux a également relevé le fait que les responsables de la mise en œuvre des informations sur la santé doivent tenir compte des besoins locaux afin de s’assurer que les intervenants considèrent les informations sur la santé comme pertinentes et fructueuses. Les interventions HIE mises en œuvre grâce à des technologies efficaces comme la télésanté/télémédecine et la santé mobile au Brésil, au Kenya et en Afrique du Sud, sont des exemples de réussite en matière d’échange d’informations sur la santé dans les PRF-PRI en dépit des ressources et des capacités limitées. Il est important que la mise en œuvre des informations sur la santé soit conforme aux priorités nationales et aux besoins locaux. El intercambio y uso de la información de salud puede ayudar a los profesionales de la salud y formuladores de políticas a tomar decisiones informadas sobre las formas de mejorar la salud del paciente y la población. Muchos países de ingresos bajos y medios (PIBMs) han sin embargo fracasado en acoger las estrategias y tecnologías para facilitar el intercambio de información de salud (IIS). Tuvimos como objetivo entender las barreras y facilitadores para la implementación y adopción del IIS en PIBMs. Dos investigadores independientemente utilizaron 11 bases de datos académicas para buscar estudios cualitativos, cuantitativos y de métodos mixtos publicados y en desarrollo, y buscaron trabajos no publicados a través del motor de búsqueda Google. Las búsquedas cubrieron el periodo entre enero de 1990 y julio de 2014 y no se restringieron por idioma. Los estudios elegibles fueron evaluados de manera independiente y crítica, y luego analizados temáticamente. Las búsquedas produjeron 5461 citas después de la deduplicación de los resultados. De estos, 56 artículos, tres abstractos de conferencias y cuatro reportes técnicos cumplieron los criterios de inclusión. La falta de importancia dada a los datos en el proceso de toma de decisiones, la corrupción y la inseguridad, la falta de entrenamiento y la pobre infraestructura fueron considerados como retos importantes para implementar el ISS, pero el liderazgo fuerte y una dirección de políticas clara, junto con el apoyo financiero para adquirir tecnología esencial, mejoran la red de comunicación y proveen entrenamiento para los trabajadores, lo cual ayuda a promover la implementación. El trabajo también destaca como los implementadores del ISS deben tener en cuenta las necesidades locales para asegurar que las partes interesadas perciban el ISS como relevante y ventajoso. Las intervenciones del ISS implementadas a través de estrategias para sobreponer barreras como la telesalud/tele-medicina y la mSalud en Brasil, Kenia y Suráfrica, son ejemplos exitosos del intercambio de información de salud en PIBMs a pesar de los recursos y capacidad limitada. Es importante que la implementación del ISS esté alineada con prioridades naciones y necesidades locales. 医疗信息的交换和使用能够帮助医疗健康专业人士和政策制定 者形成关于提高病人和人口健康方式的有效决策。然而, 许多 中低收入国家没有采用促进医疗信息交换的方式和技术。我们 致力于了解中低收入国家医疗信息交换的障碍和促进因素的实 施和应用。2名文献回顾者各自搜寻11个已出版和正在进行的 定性研究、定量研究和混合研究方法的学术数据库, 并且通过 谷歌搜索引擎搜寻未出版的研究。研究覆盖了1990年1月至 2014年7月间各类语言的文献。我们各自批判性地评估并且有 目的地分析合格的研究。在去除重复研究结果后, 本研究涵盖 了5461个引用。在这些之中, 56篇文章、3个会议纪要和4个技 术报告符合内部标准。我们认为关于决策制定、腐败和不安全 性数据重要性的缺乏, 培训匮乏和低质量基础设施是实施医疗 信息互换的主要挑战, 但是强大的领导力、明确的政策方向以 及取得重要技术的财政支持能够提升沟通系统, 为员工提供培 训, 从而帮助提升医疗信息互换的实施。研究主体同时强调医 疗信息互换的实施者如何考虑当地需求从而保证利益相关者将 医疗信息互换看做是相关的和有益的。通过交替前进技术 （例 如巴西的远程医疗、肯尼亚的远程药物和南非的远程健康） 实 施的医疗信息互换干预行为展现出中低收入国家交换医疗信息 的成功例子, 尽管各国资源和能力有限。医疗信息互换的应用 与国家有效性和当地需求联系在一起十分重要。

Health information exchange (HIE), which is the transfer of electronic information such as laboratory results, clinical summaries, and medication lists, is believed to boost efficiency, reduce health care costs, and improve outcomes for patients. Stimulated by federal financial incentives, about two-thirds of hospitals and almost half of physician practices are now engaged in some type of HIE with outside organizations. To determine how HIE has affected such health care measures as cost, service use, and quality, we identified twenty-seven scientific studies, extracted selected characteristics from each, and meta-analyzed these characteristics for trends. Overall, 57 percent of published analyses reported some benefit from HIE. However, articles employing study designs having strong internal validity, such as randomized controlled trials or quasi-experiments, were significantly less likely than others to associate HIE with benefits. Among six articles with strong internal validity, one study reported paradoxical negative effects, three studies found no effect, and two studies reported that HIE led to benefits. Furthermore, these two studies had narrower focuses than the others. Overall, little generalizable evidence currently exists regarding benefits attributable to HIE.

In the face of the rapid evolution of the COVID-19 pandemic, healthcare professionals on the frontline are in urgent need of frequent updates in the accomplishment of their practice. Hence, clinicians started to search for prompt, valid information on sources that are parallel to academic journals. Aim of this work is to investigate the extent of this phenomenon. We administered an anonymous online cross-sectional survey to 645 Italian clinicians. Target of the survey were all medical figures potentially involved in the management of COVID-19 cases. 369 questionnaires were returned. 19.5% (n = 72) of respondents were younger than 30 years-old; 49,3% (n = 182) worked in Infectious Diseases, Internal Medicine or Respiratory Medicine departments, 11.5% (n = 42) in Intensive Care Unit and 7.4% (n = 27) were general practitioner. 70% (n = 261) of respondents reported that their use of social media to seek medical information increased during the pandemic. 39.3% (n = 145) consistently consulted Facebook groups and 53.1% (n = 196) Whatsapp chats. 47% (n = 174) of respondents reported that information shared on social media had a consistent impact on their daily practice. In the present study, we found no difference in social media usage between age groups or medical specialties. Given the urgent need for scientific update during the present pandemic, these findings may help understanding how clinicians access new evidences and implement them in their daily practice.

Background Data capture is one of the most expensive phases during the conduct of a clinical trial and the increasing use of electronic health records (EHR) offers significant savings to clinical research. To facilitate these secondary uses of routinely collected patient data, it is beneficial to know what data elements are captured in clinical trials. Therefore our aim here is to determine the most commonly used data elements in clinical trials and their availability in hospital EHR systems. Methods Case report forms for 23 clinical trials in differing disease areas were analyzed. Through an iterative and consensus-based process of medical informatics professionals from academia and trial experts from the European pharmaceutical industry, data elements were compiled for all disease areas and with special focus on the reporting of adverse events. Afterwards, data elements were identified and statistics acquired from hospital sites providing data to the EHR4CR project. Results The analysis identified 133 unique data elements. Fifty elements were congruent with a published data inventory for patient recruitment and 83 new elements were identified for clinical trial execution, including adverse event reporting. Demographic and laboratory elements lead the list of available elements in hospitals EHR systems. For the reporting of serious adverse events only very few elements could be identified in the patient records. Conclusions Common data elements in clinical trials have been identified and their availability in hospital systems elucidated. Several elements, often those related to reimbursement, are frequently available whereas more specialized elements are ranked at the bottom of the data inventory list. Hospitals that want to obtain the benefits of reusing data for research from their EHR are now able to prioritize their efforts based on this common data element list.