The Journal of Bone and Joint Surgery 80:1525-32 (1998)
© 1998 The Journal of Bone and Joint Surgery, Inc.
Current Concepts Review - Internet Resources for Orthopaedic Surgeons*
GREGORY J. GOLLADAY, M.D. , ANN ARBOR,
IRA H. KIRSCHENBAUM, M.D. , NORTH WHITE PLAINS, NEW YORK,
LARRY S. MATTHEWS, M.D., ANN ARBOR and
J. SYBIL BIERMANN, M.D., ANN ARBOR, MICHIGAN
Investigation performed at the Section of Orthopaedic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, and Westchester Bone and Joint Associates, North White Plains
 |
Introduction
|
|---|
|
History
|
|---|
The origin of the Internet is credited to the United States Department of Defense7,26, which developed ARPANET (Advanced Research Projects Agency Network) in the 1960s to allow researchers across the country to collaborate reliably with use of linked supercomputers in the event of a nuclear war or another emergency. Stanford University, the University of California at Santa Barbara, the University of Utah, and the University of California at Los Angeles were the first four universities to be connected to ARPANET, by means of telephone lines, in 1969. By 1971, twenty-three institutions were participating. In 1973, the first international connections were made. The first Usenet was founded in 1979, by students at the University of North Carolina and Duke University, as an electronic forum for discussing various topics. The term Internet was coined in 1981.
In response to the growing body of relatively unorganized electronic information, the University of Minnesota released Gopher, the first software program for using the Internet, in 1991. Many educational institutions used Gopher to send and retrieve electronic data and communications. Information that was shared with use of Gopher was restricted to text and was presented to the user in a menu format. There were no images or multimedia capabilities. That same year, Tim Berners-Lee, working at the European Council for Nuclear Research (CERN) in Switzerland, developed the World Wide Web, which allowed computers to work together to transfer information more readily. He was able to improve communication between computers by standardizing the program language (hypertext markup language [HTML]) that they used and the way that files were created and stored (with use of hypertext transport protocol [HTTP]). The Web allows the use of software, termed Web browsers, to communicate with Web servers, which are the computers that house the information. The important contribution of the World Wide Web is that pictures, audio, and video can be transmitted and presented on screen. In addition, the feature of linking, which is navigating from one area in the World Wide Web to another, has increased the effectiveness and popularity of the Internet12. Mosaic, the first Web browser, became available in 1993. Since that time, the Internet has grown exponentially, with recent estimates claiming more than 115 million users worldwide6 and two million Web sites15. These numbers are estimated to double yearly. Users of Yahoo, a popular software program for searching the Internet, view an estimated thirty-eight million Web pages daily23.
|
Organizational Overview of the Internet
|
|---|
Becoming Connected
The Internet currently functions by allowing individual computers to communicate with each other regardless of the type of computer that is used (for example, a Macintosh or a PC). What makes the Internet function is an actual network of cables that connect supercomputers around the country; this network of cables is referred to as a backbone networking system. Companies called Internet service providers, such as America Online and MindSpring, connect their computer to the backbone networking system. By connecting to this network, an individual user can communicate with any other computer that is connected to the network. A user connects with an Internet service provider by means of a modem and then enters this connection environment. In order to become connected or to go online, therefore, one needs a personal computer, a modem, and a connection to an Internet service provider. The term server refers to a computer or software program that provides a specific service, such as e-mail (electronic mail) or Web access, to a client who is the user of this service. The speed of transmission is related primarily to the modem speed of the user and the host and to so-called Internet traffic (that is, the number of computers that are trying to use the Internet at a given time). Not all connections to the Internet are through Internet service providers. Direct connection to the Internet can also be accomplished through a router, which is a special type of cable. The expense of a router prohibits private use, but institutions frequently have their own routers. Access to the Internet may be through an academic institution that has this type of direct connection.
Domains
Connections to the Internet are made by means of large computers called domains. A domain is like a village, and the individual computers that share that domain are like the individual homes in the village. When a user connects to the Internet through an Internet service provider, he or she is connecting through the domain. In the Internet, all domains have unique names. The domain through which a user signs on is one part of his or her unique address on the Internet. It is through this address that an individual can be found. Domains define e-mail addresses as well as Web sites. The unique nature of each of the names prevents confusion in the transfer of information. A non-profit organization called Internic administers domain names. Users register with Internic when a new domain name is needed.
The names of domains consist of two components: first a special identifying name, and second an Internic grouping or distinction. The Internic distinction is a three-letter suffix that defines the type of domain. Current domain types include com (a commercial organization), org (a non-profit organization), net (a network company), edu (an educational facility), and others. It is likely that there will be future expansions of these distinctions.
Modes of Communication
The operative word in the Internet is communication. Understanding the variety of methods that are used to communicate over this elaborate international network of computers allows users to optimize their involvement on the Internet. Generally, communication is directed to one person or computer, directed to many other people or computers, or posted on the Internet where it can be accessed by virtually any person or computer. Putting this in computer terms, the user can send or receive e-mail, communicate by means of a so-called mailing list, share information through a so-called newsgroup, or view and even develop information on the World Wide Web through a Web site.
E-Mail
E-mail (electronic mail) is the most common and powerful method of communication on the Internet. In its simplest form, a user connects to the Internet service provider through a modem, types a message on the computer, and then sends the message to another person. When the recipient signs on to his or her Internet service provider, he or she may access the e-mail server and retrieve his or her mail. Received mail can be stored, deleted, forwarded to other addresses, or responded to. E-mail addresses may be stored in an electronic address book for future reference. E-mail addresses are unique, just as regular post-office addresses are. An e-mail address has two components: the individual name and the domain name. For example, in the e-mail address jcharnley@hips.com, the domain name is hips.com (the Internet service provider onto which the user has signed) and the user's unique name within that domain is jcharnley.
Current e-mail resources are quite extensive. With modern e-mail software, one can send e-mail messages to multiple users simultaneously. In addition, one can attach images and complete text files. (In fact, we collaborated on the development of this article through e-mail.) E-mail software allows the user to set up automatic replies or transfers or to filter or block certain messages. Because e-mail is not legally or practically protected from unauthorized viewers, confidential or sensitive files should be encrypted12.
Mailing Lists
Mailing lists are made up of users who subscribe to receive e-mail related to a particular topic of interest to the members on the list. All of the messages sent to the mailing list are transmitted to all subscribers, and any subscriber can send messages to the list. All messages are received directly into an e-mail mailbox. To subscribe to a mailing list, one needs only to e-mail the list address dealing with a topic about which the subscriber is interested. The uniform resource locator (URL) http://www.liszt.com provides a fairly comprehensive directory of currently available mailing lists. Mailing lists of interest to orthopaedic surgeons include the American Academy of Orthopaedic Surgeons discussion groups, Orthopod, the Scoliosis Mailing List, and the Electronic Journal of Orthopaedics Mailing Lists (Table I). Caution should be used, as some mailing lists have a very high volume of messages and may flood the recipient with mail. When subscribing, an individual receives important administrative information, including the mechanism for removing his or her address from the mailing list; this information should be retained and stored for future use.
Newsgroups
Newsgroups function as electronic bulletin boards on which users may post messages and participate in discussions with newsgroup readers. Unlike mailing lists, which send messages to the e-mail mailboxes of all subscribers, newsgroups are accessed by the user, who views all posted messages and decides which ones to read or to download. Web browsers as well as special software for reading newsgroups can provide an organizational structure whereby a newsgroup user may view messages and responses to postings on a single topic in the order that the messages were posted16. A listing of newsgroups by category and a mechanism to search for a discussion related to a topic can be found at http://www.dejanews.com. Most newsgroups have introductory postings to educate interested parties about the function and interest of the newsgroup. Moderated newsgroups are edited by a knowledgeable individual who screens all messages for irrelevant or inappropriate content and determines which messages will be posted. Unmoderated newsgroups are not filtered, and messages are posted as soon as they are sent. Some newsgroups are of particular interest to orthopaedic surgeons (Table II).
Netiquette
The heavy volume of users and the competing traffic with e-mail, newsgroups, and mailing lists have led to new social protocols on the Internet, which are termed netiquette. For example, many Web sites have an icon, FAQ (Frequently Asked Questions), which helps visitors with common queries. To ask questions without having first reviewed the FAQ is considered unmannerly. Typing a message in all capital letters is akin to shouting. The use of derogatory or abusive language (flaming) is also rude12. Sending large numbers of e-mails with relatively useless information is called spamming. Familiarity with and use of appropriate netiquette helps to keep the Internet a productive and positive environment.
World Wide Web
The terms Internet and World Wide Web are frequently used interchangeably, but they actually refer to different entities. The World Wide Web is a method of communicating within the Internet; it is not the Internet itself.
The major concept that dominates the Web is the one of links. Links allow a user to navigate anywhere on the Web by clicking on a navigation point. This point can be a word or even an image. A link can be to another section of the document being viewed or to anywhere on any Web site in the world. Links allow rapid exploration of information and, in essence, allow one to construct virtual customized textbooks on any topic. The links on the World Wide Web are written in the form of hypertext with key words or phrases highlighted in color, underlined, or italicized. A user may retrieve documents from different Web sites either by following search matches or by linking to interconnected items. When a user clicks on hypertext, he or she is connected to a different Web page. The circuitous route through the World Wide Web that Internet users often travel with use of hyperlinks is called surfing.
Web sites work according to the concept of Web pages. Each page has its own unique address within a domain, and links accurately send the user to desired locations in another or the same document. The address of each Web page is referred to as its uniform resource locator. The software that allows viewing of Web pages is called a browser (such as Microsoft Explorer, Netscape Navigator, or more recently Netscape Communicator). Browsers find and display Web pages for the user. Web pages from a single person or organization are organized into Web sites. Web sites usually start with a home page, which functions as a table of contents for the Web site. As the location of each Web page is unique, pages may be located with use of the find function on the browser or by searching the Internet for keywords by means of a search engine such as Yahoo, Web Crawler, Infoseek, or Lycos. The search engines are software tools that index Web documents by keywords. Although the Web browser can find a location or a specified Internet address, the search engines are able to scan the entire Internet for documents that may contain information related to the keywords being searched. By typing in a uniform resource locator or by selecting search matches, the user is connected to a specific Web page. Sometimes the time spent searching for Web sites of interest is also referred to as surfing the Web.
Although the best way to become proficient on the World Wide Web is to practice, three techniques can increase efficiency. The first technique is the use of bookmarks to tag Web addresses for easy retrieval later without having to enter a long uniform resource locator or to use a search engine. The second method is downloading files of interest rather than reading them in entirety while connected to the server. This practice limits user time on the Internet, which typically is billed or allotted in hourly increments. The third technique is to find link pages, which are Web sites related to a given subject that usually have a description of relevant sites along with hypertext links.
|
Orthopaedic Resources on the Internet
|
|---|
Current Internet resources include mailing lists, newsgroups, online journals and texts, chat rooms, practice management aids, online consulting, case presentations, continuing medical education, and so on; the list is too extensive to itemize. Web sites are sponsored by academic institutions, corporations, or individuals. Many physicians and institutions now advertise their services and provide information to patients online. The rapid growth in this area is staggering. According to a recent survey of 314 hospitals in forty-four states, an estimated 20.4 per cent of hospitals use the Internet for marketing and 52 per cent of those not currently marketing on the Web intend to do so in the coming months8. A data server dedicated to trauma demonstrated a 650 per cent increase in usage (from eighty files transmitted per day to 600 files per day) during a six-month period2. A site on pediatric surgery also showed considerable growth25.
Online Organizations
The Web site of the American Academy of Orthopaedic Surgeons (Table III) is a complete resource of materials related to the Academy, and it has recently been expanded to allow Academy members to register for meetings and purchase its products. In the coming year, online continuing medical-education courses and discussion groups will be expanded. Helpful features include information on upcoming meetings, the ability to do searches on Medline, and a catalogue of educational materials available through the American Academy of Orthopaedic Surgeons. Discussion groups, including unmoderated groups, clinical discussion groups, international discussion groups, and others, are available to members. Most of the discussion groups are specialty-specific. Many subspecialty societies have links from the American Academy of Orthopaedic Surgeons site. Many other orthopaedic organizations have Web sites available (Table III).
Online Textbooks
There have been a number of attempts to develop textbooks completely online. Most of these have been reviews of the current knowledge base with links to resource sites. One online textbook is Wheeless' Textbook of Orthopaedics (http://www.medmedia.com), developed by C. R. Wheeless, M.D., in collaboration with Eugene Sherry, M.D., and the WorldOrtho Web-site team (http://www.worldortho.com/) in Australia. The advantage of the online texts is that information can be pooled from multiple sites, including other texts, journals, lectures, and clinical experiences. There are virtually no space limitations in amassing information. Eatonhand (http://www.eatonhand.com) is a similar reference that is devoted exclusively to hand surgery. Many of these online texts are in their infancy. As the content on the Web becomes more extensive, these texts will offer richer material and more links.
Online Journals
There has been a recent proliferation of journals online, but the development of online journals is still somewhat limited. There appears to be a bit of a struggle in the print media concerning what to offer on the Internet when a concurrent printed text is available. Some printed journals, such as The Journal of Bone and Joint Surgery (both the American and the British volume), are available entirely or in part on the Internet (Table IV). Although few orthopaedic journals have elected to publish their entire contents on the Internet, several have begun to list their table of contents, authors, and even abstracts on their Web sites. A growing number of printed journals now allow electronic submission of manuscripts. Critiques and revisions may be transferred electronically, improving the ease and speed of publication.
The Electronic Journal of Orthopaedics, edited by Jeffrey Reuben, M.D., Ph.D., is an example of a true Internet publication. Dr. Reuben developed so-called smart tools that showcase the powerful potential of an Internet presence. For example, an individual submits a manuscript electronically. On the basis of the subject matter, the manuscript, with images, is automatically routed to the proper reviewer. After the review, the manuscript is either sent back to the author or automatically posted on the journal online. In addition, the journal supports user comments and discussion groups.
A more complete list of orthopaedic journals on the Internet can be found at the Orthopaedic Web Links USA Mirror Site at http://www.bonehome.com/owl/publica.html.
Link Sites
In an effort to organize the growing tide of information, a number of orthopaedic surgeons around the globe have developed orthopaedic Web sites with a plethora of functions (Table V). Many contain links to Web sites of interest to orthopaedic surgeons, such as organizations, textbooks, and journals. Many of these sites also provide information on cases, critiques of other sites, and the opportunity to chat with other surgeons or to leave messages and commentary. To avoid duplication of effort, several of these orthopaedic Webmasters have coordinated their efforts to produce Orthopaedic Web Links (OWL), edited by Myles Clough, M.D., from British Columbia. They have then posted Orthopaedic Web Links on servers in several different countries. Since the speed of transmission on the Internet is related in part to the distance traveled, so-called mirror sites on many continents allow users to access the Orthopaedic Web Links site closest to them.
Additional Online Resources
Bone Home (http://www.bonehome.com) is a site that offers international case presentations, a royalty-free image bank, operative techniques, postoperative protocols, an online bookstore, free software and shareware to download, practice management resources, links to Medline searches, and other features. The online bookstore at this site provides information about orthopaedic and other textbooks with the opportunity to purchase by entering credit-card and delivery information. Free software as well as shareware, which is software that can be downloaded and used on a trial basis with the understanding that payment will be sent later if the software is kept, is also available. WorldOrtho (http://www.worldortho.com), based in Sydney, Australia, is another site that contains a comprehensive orthopaedic database, case presentations, and image gallery and even allows for online consulting. Orthopaedic Web Links are listed at http://www.worldortho.com/links.html. Another interesting Web site is Belgian Orthoweb (http://www.belgianorthoweb.be/index_uk.htm), which has a large amount of resource material on orthopaedics. Resources on patient education can be found at the Medical Multimedia Group Home Page (http://mmg.sechrest.com/mmg/), where there is elaborate patient-education material for viewing, downloading, and purchasing.
A catalogue of biomedical information that is available on the Internet can be found at the Virtual Library of Medicine (http://www.ohsu.edu/cliniweb/wwwvl/). Medline searches may be conducted through http://www.healthgate.com/HealthGate/MEDLINE/search- advanced.shtml/. Other valuable sites include the National Institutes of Health (http://www.nih.gov/) and the National Library of Medicine (http://www.nlm.gov/). Information on continuing medical-education credit may be obtained at http://www.ama-assn.org/cgi-bin/cme-redir.
|
New Issues Related to Electronic Media
|
|---|
The ubiquity and uniqueness of the Internet as a source of medical information create a novel set of issues involving peer review, accuracy, and confidentiality.
A New Generation of Informed Patients
Before the development of the so-called information superhighway, access to medical information by laypersons was limited13. Grateful Med and other information sources that allowed Medline searches and had other capabilities facilitated electronic information delivery. Patients are now going online to learn about their disease, treatment, and prognosis. Widman and Tong identified seventy inquiries in twelve months from patients or families on a site focusing on cardiac arrhythmias. In a recent article on free-nets, Clark suggested the possibility that online information may decrease emergency or other medical visits, which could decrease health-care costs. A potential downside to the Internet is the relative lack of peer review regarding information that is made available13,21. According to a study from Canada, 45 per cent of the dietary information available on the Internet was found to conflict with standard dietary recommendations, and it was proposed that many of those contradictions were related to alternative medicine4. Patients who have done research on the Internet bring to the doctor-patient encounter a set of knowledge and expectations based on their findings that may or may not have a basis in fact or mainstream medical acceptance13.
Credibility
Both patients and physicians may have difficulty discerning what information on the Internet is credible. Patients may turn to the Internet for information because their physicians have not educated them or because standard searches in medical libraries or texts may be too complex to be well understood by the layperson14,22.
A recent article put forth a set of standards to ensure quality in Internet publication20. These include designation of authorship, attribution of references, disclosure of ownership and sponsorship, and provision of the date of posting and of updating. These standards are important to avoid dissemination of misinformation and to prevent confusion between what the authors called "science and snake oil," the distinction between which may not be readily apparent to the unwary patient who uses the Internet. Various Web sites have been developed to rate quality or designate approval of medical information on the Internet. Jadad and Gagliardi evaluated forty-seven such sites. Thirteen sites were evaluated in depth. The authors concluded that these instruments are incompletely developed, and they suggested that it might be impossible to develop a set of useful tools for the evaluation of medical information on the Internet because of its dynamic, vast nature. We recently developed an objective, reproducible, and reliable system for the evaluation of medical information that is available on the Internet (unpublished data), which considers medical information with regard to posting source, relevance, and peer review.
Physicians must be proactive in helping to identify Web sites that provide accurate, useful information17. We should be in the forefront with respect to the development of novel and clinically useful applications for the Internet.
Confidentiality
The issue of patient confidentiality and security of information on the Internet is also being addressed1,19. Doyle suggested that patient information be contained on a confidential personal clinical Web page, much like an online Medic Alert bracelet. However, patients are not the only ones whose information is online. Patients can now determine if their doctor is board-certified by accessing a Web site (http://www.certifieddoctor.org/) and inquiring. The American Medical Association maintains a database with information on both member and non-member physicians. Information about the National Practitioner Databank is present on a Web site, although at the time of writing actual information regarding a specific practitioner must be requested and will be sent by means of conventional methods rather than directly queried from the site.
|
Future Directions
|
|---|
The costs of conventional medical journals have been rising steadily, whereas the funding available to physicians for education and the budgets of health-science libraries have been decreasing. In developing countries, there is a growing need for access to medical literature11. It is likely that online journals will continue to proliferate and may even become the norm in years to come10. Furthermore, as increasing numbers of users join the system, conventional biomedical journals will compete with other media as the primary providers of information to the medical community.
As the volume of information steadily increases, current all-purpose search engines will become less helpful for finding information on a specific medical topic. Specific medical search engines are currently in use, including a useful orthopaedic search engine (http://www.orthosearch.com/), which is available now and is continuing to be developed and improved. At the 1998 Annual Meeting of the American Academy of Orthopaedic Surgeons, a group of orthopaedists who were interested in the Internet met and discussed plans for Orthogate, a developing organization that has a primary focus on Internet applications for orthopaedics, with a special interest in the quality and availability of information.
Online consulting currently is available. The technology for telemedicine, which allows physicians to evaluate patients at a remote location with use of sight and sound, currently exists but is prohibitively expensive and is limited to a few centers. However, it is likely that, as the technology improves and decreases in cost, use of this service will be expanded. Issues of licensure and malpractice will need to be addressed as these applications are developed.
Advertising on the Internet is likely to increase as more surgeons go online. While companies that provide orthopaedic implants and other goods currently advertise in the more expensive print medium, it is likely that, with increasing use of electronic mailing lists, companies will tap into this relatively inexpensive way of reaching thousands of potential customers.
Multi-institutional database acquisition18 is being explored in several fields and will likely become a reality within a few years. For example, the Connective Tissue Oncology Society (http://www.cancer.med.umich.edu/ctos/index.html) is developing a clinical database to allow multiple investigators to add patient data, with the expectation that large, multicenter clinical studies will be facilitated.
The development of intelligent Internet tools will further increase the value of orthopaedic knowledge in this medium. The development of orthopaedic search engines is well under way, as are tools to develop applications for electronic medical records. Such tools will make it easier to search for and integrate the massive amount of information that is pouring into the Internet on a daily basis. The current environment on the Internet related to orthopaedic surgery is an exciting one that will clearly expand further in the coming years.
|
Footnotes
|
|---|
*One or more of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
Section of Orthopaedic Surgery, Department of Surgery, University of Michigan, 2912 Taubman Center (G. J. G. and L. S. M.) and 7304 CCGC (J. S. B.), 1500 East Medical Center Drive, Ann Arbor, Michigan 48109. E-mail address for Dr. Biermann: biermann@umich.edu.
Westchester Bone and Joint Associates, 7 Reservoir Road, North White Plains, New York 10603.
|
References
|
|---|
-
Anderson, R.: NHS-wide networking and patient confidentiality. BMJ: British Med. J., 311: 5-6, 1995.[Free Full Text]
-
Block, E. F., and Mire, E. J.: Trauma on the Internet: early experience with a World Wide Web server dedicated to trauma and critical care. J. Trauma, 41: 265-270, 1996.[Medline]
-
Clark, D. E.: A comparison of health information on Florida's free-nets. Bull. Med. Lib. Assn., 85: 239-244, 1997.
-
Davison, K.: The quality of dietary information on the World Wide Web. Clin. Perform. and Qual. Healthcare, 5: 64-66, 1997.
-
Doyle, D. J.: Surfing the Internet for patient information: the personal clinical Web page [letter]. J. Am. Med. Assn., 274: 1586, 1995.[Abstract/Free Full Text]
-
"How many online?": NUA Internet surveys. URL: http://www.nua.ie/surveys/how_many_online/world.html. Accessed April 23, 1998.
-
Howe, W.: A brief history of the Internet. URL: http://www.delphi.com/navnet/faq/history.html. Accessed March 29, 1998.
-
Internet ... very few hospitals are surfing it right now [news]. Hosp. and Health Networks, 71: 14, 1997.
-
Jadad, A. R., and Gagliardi, A.: Rating health information on the Internet: navigating to knowledge or to Babel?. J. Am. Med. Assn., 279: 611-614, 1998.[Abstract/Free Full Text]
-
LaPorte, R. E.; Marler, E.; Akazawa, S.; Sauer, F.; Gamboa, C.; Shenton, C.; Glosser, C.; Villasenor, A.; and Maclure, M.: The death of biomedical journals. BMJ: British Med. J., 310: 1387-1390, 1995. URL: http://194.216.217.166/archive/6991ed2.htm. Accessed April 2, 1998.
-
LaPorte, R. E.; Akazawa, S.; Hellmonds, P.; Boostrom, E.; Gamboa, C.; Gooch, T.; Hussain, F.; Libman, I.; Marler, E.; Roko, K.; Sauer, F.; and Tajima, N.: Editorial. Global public health and the information superhighway. BMJ: British Med. J., 308: 1651-1652, 1994.[Free Full Text]
-
Levine, J. R.; Baroudi, C.; and Young, M. L.: The Internet for Dummies. Ed. 5. Foster City, California, IDG Books Worldwide, 1998.
-
Lowes, R. L.: Here come patients who've "studied" medicine on-line. Med. Econ., 74: 175-184, 1997.[Medline]
-
Mack, J.: Quality of medical information on the Internet [letter]. J. Am. Med. Assn., 278: 632, 1997.
-
The Netcraft Web Server Survey. URL: http://www.netcraft.com/survey. Accessed April 23, 1998.
-
Peters, R., and Sikorski, R.: Digital dialogue. Sharing information and interests on the Internet. J. Am. Med. Assn., 277: 1258-1260, 1997.[Abstract/Free Full Text]
-
Peters, R., and Sikorski, R.: The cardiology beat. An Internet education for patients and health professionals. J. Am. Med. Assn., 278: 451-452, 1997.[Abstract/Free Full Text]
-
Phillips, N. I.: Neurosurgery and the Internet. British J. Neurosurg., 10: 555-558, 1996.[Medline]
-
Sharma, P.: Popular medical information on Internet [letter]. Lancet, 346: 250, 1995.
-
Silberg, W. M.; Lundberg, G. D.; and Musacchio, R. A.: Editorial. Assessing, controlling, and assuring the quality of medical information on the Internet. Caveant lector et viewor—let the reader and viewer beware. J. Am. Med. Assn., 277: 1244-1245, 1997.[Abstract/Free Full Text]
-
Sonnenberg, F. A.: Health information on the Internet. Opportunities and pitfalls. Arch. Intern. Med., 157: 151-152, 1997.[Abstract/Free Full Text]
-
Strauss, K.: Quality of medical information on the Internet [letter]. J. Am. Med. Assn., 278: 632, 1997.
-
Treese, W.: The Internet index. URL: http://www.openmarket.com/intindex/. Accessed March 29, 1998.
-
Widman, L. E., and Tong, D. A.: Requests for medical advice from patients and families to health care providers who publish on the World Wide Web. Arch. Intern. Med., 157: 209-212, 1997.[Abstract/Free Full Text]
-
Wulkan, M. L.; Smith, S. D.; Whalen, T. V.; and Hardin, W. D., Jr.: Pediatric surgeons on the Internet: a multi-institutional experience. J. Pediat. Surg., 32: 612-614, 1997.[Medline]
-
Zakon, R. H.: Hobbes' Internet timeline v3.1. URL: http://www.isoc.org/zakon/Internet/History/HIT.html. Accessed March 29, 1998.
 CiteULike  Connotea  Del.icio.us  Facebook  Technorati  Twitter What's this?
This article has been cited by other articles:
|
|
|
|
 
F. A. Farley and S. L. Weinstein
The Case for Patient-Centered Care in Orthopaedics
J. Am. Acad. Ortho. Surg.,
August 1, 2006;
14(8):
447 - 451.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. K. Beredjiklian, D. J. Bozentka, D. R. Steinberg, and J. Bernstein
Evaluating the Source and Content of Orthopaedic Information on the Internet : The Case of Carpal Tunnel Syndrome
J. Bone Joint Surg. Am.,
November 1, 2000;
82(11):
1540 - 1540.
[Abstract]
[Full Text]
|
|
|
|
Top
Introduction
History