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Evidence-based Medical Practice: A Canadian Website Directory and Instrument to rate quality.
- France Légaré , Md, MSc, (F)CCMF, Michel Labrecque MD PhD, Pierre Frémont MD PhD, Lucie Baillargeon MD MSc, Lucie Misson RN, Pierre Beaupré MD, Michel Cauchon MD (9 March 2002)
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Overrated Perception of the Internet by Medical Students of a Developing Country
- Pedro Horna, Walter H Curioso M.D. (12 March 2002)
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tools for scoring miscarraige websites
- j christopher r. hardwick, Fiona M. MacKenzie (18 March 2002)
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France Légaré , Md, MSc, (F)CCMF, Clinical Teacher Département de médecine familiale, Université Laval, Québec, Québec, Canada, Michel Labrecque MD PhD, Pierre Frémont MD PhD, Lucie Baillargeon MD MSc, Lucie Misson RN, Pierre Beaupré MD, Michel Cauchon MD
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Dear Editor: Gagliardi and Jadad have systematically reviewed instruments used to rate quality of health information on the internet (1). We welcome their initiative but would like to bring to your attention an initiative and an instrument by the department of family medicine at Laval university, Canada. Since 1998, our team of researchers, educators and clinicians in family medicine have dedicated many hours to develop and maintain a website that offer a directory of websites which includes a rating scale based on proven, objective criteria (2). This is an initiative that was originally funded by our regional health board but also by Health Canada. The development of our critical appraisal tool was inspired by the general principles of another project in which one of our researchers (PF) participated (3). At the time we initiated our process, there was no well- established website appraisal standards. Thus, we had to develop our own criteria by face validity. We decided to attribute 60% of the rating to the eight content-related criteria, while the remaining 40% was assigned to the nine criteria relating to the organization and presentation of the site. This distribution was to ensure that the appearance of the site did not distract from the quality of its content (4). Briefly, our overall process is based on a systematic approach in which we use French and English keywords to search Alta Vista, Infoseek, Yahoo, HotBot, Google and Copernic to retrieve websites which offered clinical evidence-based medical information. We also use “snowballing” strategies to seek from other sources eligible websites. Two family physicians apply a first screening tool which ensures the eligibility of a website. When a website is deemed eligible, two other colleagues use our instrument to rate quality of the website. Discrepancies are resolved by consensus. At this point in time, we have appraised more than 200 websites (5). We are currently posting 115 websites that have successfully passed trough the whole process. We have been invited to publish the evaluation of each of these website in the journal of the Canadian College of Family Physician (6-9). We also disseminated our initiative in national and international conferences such as The Canadian Cochrane Symposium in 1999, the International Cochrane Colloquium in 2001, the 27th Annual Meeting of the North American Primary Care Research Group, 1999 and the World Conference in Heidelberg on Medicine and the Internet, 2000 (10-14). The latest website that was critically appraised was the Cancer Care Ontario Practice Guidelines Initiative on 2002-06-02 (15). Last November, our initiative received a prize of excellence from the Québec provincial association of hospitals (16). Members of this association are decision makers at all levels of the health care system in our province. This is an active lobby group in the health care reform. Thus we were pleased to see that our initiative was receiving recognition from outside the medical community. We welcome yourself and your readers to visit our website (http://www.medecine.quebec.qc.ca/english/repertoire.htm) and would be happy to receive your comments. Respectfully yours References: 1. Gagliardi A, Jadad AR. Examination of instruments used to rate quality of health information on the internet: chronicle of a voyage with an unclear destination. BMJ 2002; 324: 569-573[Abstract/Full Text]. 2. Département de médecine familiale, Université Laval. Evidence-based medical practice. http://www.medecine.quebec.qc.ca/english/methodes.htm Accessed March 8th 2002. 3. Ellis C, Frémont P, Quigg MT. Rating medical websites for family physicians. 18th Annual Workshop, Section of Teachers, College of Family Physician of Canada, Ottawa, Oct.96 4. Frémont P. Labrecque, M. Légaré, F. Baillargeon, L. Misson, M. Evaluation des sites web médicaux : fidélité inter-observateur et intra- observateur d’un outil d’évaluation. Can Fam Physician, 2001; 47 : 2270- 78. 5. Cauchon M. Labrecque M. Misson L. Légaré F. Frémont P. Baillargeon L. A critically appraised directory of Evidence-Based Medicine websites (sous presse, Journal of Family Practice) 6. Cauchon M, Baillargeon L, Légaré F, Beaupré P. Website Reviews. Can Fam Physician, 2002; 48 : 138-139. 7. Cauchon M, Baillargeon L, Légaré F, Beaupré P. Pratique médicale preuve à l’appui sur le Web. Can Fam Physician, 2002; 48 : 140-141. 8. Baillargeon L, Cauchon M, Béland G, Labrecque M, Légaré F. Website Reviews. Can Fam Physician, 2001 ; 47 : 2326. 9. Baillargeon L, Cauchon M, Béland G, Labrecque M, Légaré F. Pratique médicale preuve à l’appui sur le Web. Can Fam Physician, 2001 ; 47 : 2328- 29 10. Légaré F., Labrecque M., Baillargeon L., Frémont P., Misson L. A francophone Web site devoted to assessing the best evidence based medicine web sites. The Canadian Cochrane Symposium. The Impact of the Cochrane Collaboration : Past, Present and Future. Hamilton. November 19, 1999. 11. Baillargeon L, Labrecque M, Légaré F, Frémont P, Misson L. Critical appraisal of evidence-based Web sites. 27th Annual Meeting, North American Primary Care Research Group, San Diego, California, 7-10 novembre 1999. 12. Labrecque M. Baillargeon L. Cauchon M. Frémont P. Légaré F. Misson L. The Laval University Evidence-Based Medical Practice Web Site: Creating and Updating an Internet Directory of Evidence-Based Medicine Web Sites. World Conference in Heidelberg on Medicine and the InternetDepartment of Clinical Social Medicine of the University of Heidelberg (chief organiser: Dr.Gunther Eysenbach) Sept. 2000. 13. Frémont, P. ; Labrecque, M. ; Baillargeon, L. ; Cauchon M; Légaré, F. ; Misson, L. Un site Internet de langue française dédié à la pratique médicale fondée sur les preuves scientifiques dans Internet. Collège National des Généralistes Enseignants de France, Brest, novembre 2000. 14. Cauchon M, Labrecque M, Baillargeon L, Frémont P. Légaré F, Misson L. A directory of critically appraised evidence-based medicine websites. 9th International Cochrane Colloquium, 9-13 October 2001, Palais des Congrès, Lyon-France, p.70. 15. Cancer Care Ontario Practice Guidelines Initiative. Critical Appraisal. http://www.medecine.quebec.qc.ca/english/reponse4.asp. Accessed march 8th 2002. 16. Frémont P, Labrecque M, Légargé F, Baillargeon L, Cauchon M, Beaupré P. Pratique médicale fondée sur les preuves scientifiques. Congrès de l’Association des hôpitaux du Québec, 24-25 novembre 2001, Laval, Québec. Récipiendaire d’un prix d’Excellence Informatique-Santé à titre de projet porteur technologies cliniques de l’information. http://www.ahq.org/apropos/prix/prixis2001-porteurs.pdf . Accessed march 8th 2002. France Légaré, MD, MSC, (F)CCMF for the Université Laval research group on EBM websites Doctoral student Population Health Program University of Ottawa Clinical teacher Département de médecine familiale Université Laval Québec, Québec Canada G1K 7P4 courriel: france.legare@mfa.ulaval.ca please visit us at: http://www.medecine.quebec.qc.ca/ http://www.crsfa.ulaval.ca/umf/ |
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Pedro Horna, M.D. Universidad Peruana Cayetano Heredia, Apartado 4314, Lima-100, Peru., Walter H Curioso M.D.
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To the Editor: In this week´s issue of the BMJ, A Gagliardi and A Jadad (1) reviewed a series of initiatives directed to asses the quality of websites, noting that “whether they make a difference is a subject of further research”. We believe that in order to make a difference in the quality of data retrieved by consumers of health information on the Net, there are other equally relevant issues, besides adequate rating instruments, that should be seriously considered. One of them relates to the idea people have about the giant library called the World Wide Web and the information available on it. To illustrate our point of view, we would like to bring to the readers´ attention some of the unpublished results of a survey we conducted on a random sample of 275 medical students at our university in Lima (Peru). The answers to two specific questions (Table 1) suggest that overall, this group of students had unfounded high expectations about the quality of information available on the Net. For example, more than half of them declared that, in their opinion, most or all of the health information on the Internet comes from a trustful source (can be cited in a paper, book or thesis). This overrated perception of the Web strikingly differs with what has been systematically reviewed and published about the quality of health related webpages on the Internet (2,3). Furthermore, we believe that it could led to misinterpretation and even misuse of the medical information found on the Net by these medical students. In conclusion, we suggest that the idea people have about the Internet be reviewed as a possible issue related to the poor quality of medical information retrieved from the Net by medical students in developing countries and probably also by patients and other users of health information. TABLE 1 What kind of information do you believe is possible to find free of charge on the Net about most speciality health topics? Specific and extensively detailed information (30.2%) Specific but poorly detailed information (49.5%) Very general information (18.9%) It is not possible to find this kind of information on the Net (1.4%) In your opinion, What proportion of the health information on the Net comes from a trustful source?(Can be cited in a paper, book or thesis) All (5.0%) Most (53.8%) Some(39.8%) None (1.4%) 1. Gagliardi A, Jadad AR. Examination of instruments used to rate quality of health information on the internet: chronicle of a voyage with an unclear destination. BMJ 2002; 324: 569-573 2. Impicciatore P, Pandolfini C, Casella N, Bonati M. Reliability of health information for the public on the world wide web: systematic survey of advice on managing fever in children at home. BMJ 1997;214:1875-1881. 3. Griffiths K, Christensen H. Quality of web based information on treatment of depression: cross sectional survey. BMJ 2000;321:1511-1515. |
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j christopher r. hardwick, spr obs and gyn princess royal maternity hospital, glasgow, G31 2ER, Fiona M. MacKenzie
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Dear Sir, Gagliardi and Jadad(1) show the continuing expansion of rating tools used to assess websites containing health information. These are unproven and may have short lifespans as do many of the websites they are designed to assess. We have also found two of these tools unhelpful for assessing websites concerned with miscarriage. In order to assess relevant websites we searched two commonly used search engines with a UK bias (www.Lycos.co.uk and www.MSN.co.uk) to identify sixty potential websites via each search engine. Nineteen websites were found, many had repeated ‘hits’. Websites were then compared to a condensation of the recommendations in the RCOG guidelines(2). The websites were also scored against scoring systems derived from HON recommendations and Silberg’s paper to give scores seen in table I(3,4). Each site was scored by each author independently and a mean score calculated. Information concerning miscarriage contained within these websites scored poorly against the RCOG guidelines. The website scoring systems did not predict the RCOG scores for a website when correlations were calculated using the Spearman co-efficient [HON score RS=0.193 (95% confidence interval –0.286 to 0.595), Silberg score RS=0.035 (95% confidence interval –0.426 to 0.482)]. It is reassuring that the public find health websites helpful(5), although at present there is no proven way to direct these end-users to the most helpful websites. Satisfaction with websites may be due more to being able to review a topic at leisure or repeatedly than the volume of information included. It would be interesting to find out also if these end-users can judge the level of corporate or drug-company input into websites i.e. to distinguish between advertisements and others. Yours sincerely, Dr J. Christopher R. Hardwick Dr Fiona M. MacKenzie Department of Obstetrics and Gynaecology, 4th Floor, Princess Royal Maternity Hospital, 16 Alexandra Parade, Glasgow G31 2ER 1. Gagliardi A, Jadad AR. Examination of instruments used to rate quality of health information on the internet: chronicle of a voyage with an unclear destination. BMJ 2002;324:569-573. 2. Silberg WM, Lundberg GD, Musacchio RA. Assessing, Controlling, and Assuring the Quality of Medical Information on the Internet. JAMA 1997;277:1244-1245. 3. http://www.hon.ch/HONcode/Conduct.html. 4. http://www.rcog.org.uk/guidelines/guideline25.html 5. Ferguson T. From patients to end users. BMJ 2002;324:555-556. Table I. Overall Website Scores. Silberg score (max 9) median 2 range 0-4.5 HON score (max 8) median 3.5 range 1.5-6.5 RCOG score (max 12) median 4.5 range 1.0-8.0 |
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