Is it worth investing in online continuous education for healthcare staff?

Educational activities for hospital staff don't easily match with the congestive rhythm of healthcare personnel working life. Online learning could make it easier for healthcare personnel to attend courses, but there is still uncertainty about the feasibility of using distance learning to effectively meet education goals in healthcare institutions. Fondazione Salvatore Maugeri (FSM) started an online educational program, as pilot project, in October 2010. The present study hence is aimed at evaluating the impact of this initiative (in terms of extent and intensity of healthcare staff attendance; objective and subjective effectiveness) in order to take informed decisions for the future. In 15 months, 5 elearning courses have been provided to 2261 potential users of 14 FSM hospitals, in parallel with traditional education. 1099 users from all the hospital have intensively attended the courses (58% of nurses, 50% of therapists, 44%, of technicians, 25% of physicians) for a total of 27459 CME credits. Effectiveness in terms of knowledge gain is satisfactory and subjective evaluation is good (more than 95% of satisfied users). Elearning is not appropriate for all the educational needs and is not a panacea, but the reported results point out that it may be an effective and economically convenient mean to support massive educational interventions reaching results hardly attainable with traditional education. Users should be better educated about how to exploit online education at best.

E-learning for neurological bladder management.

Regarding the impact of visceral dysfunction on quality of life, bowel and bladder management is a very important problem. The management of the patient with neurological bladder is often a source of uncertainty for both patients and healthcare personnel. Since the need of specialized training is growing, two CME e-learning courses have been developed to provide physicians and nurses competencies for the enhancement of the daily life of the patients. The present study aims at evaluating courses attendance and outcomes. Attendance data confirm the interest for both courses. The results document a pretty good objective and subjective effectiveness of the e-learning courses but low attitude to exploit he support of an asynchronous tutor. The analysis of test results gives some hints for eventual quality improvement of the courses themselves.

Online education in a large scale rehabilitation institution.

Large scale multiple venue institutions face problems when delivering educations to their healthcare staff. The present study is aimed at evaluating the feasibility of relying on e-learning for at least part of the training of the Salvatore Maugeri Foundation healthcare staff. The paper reports the results of the delivery of e-learning courses to the personnel during a span of time of 7 months in order to assess the attitude to online courses attendance, the proportion between administered online education and administered traditional education, the economic sustainability of the online education delivery process. 37% of the total healthcare staff have attended online courses and 46% of nurses have proved to be the very active. The ratio between total number of credits and total number of courses for online and traditional education are respectively 18268/5 and 20354/96. These results point out that eLearning is not at all a niche tool used (or usable) by a limited number of people. Economic sustainability, assessed via personnel work hour saving, has been demonstrated. When distance learning is appropriate, online education is an effective, sustainable, well accepted mean to support and promote healthcare staff's education in a large scale institution.

Online CME usage patterns.

The paper reports the findings of the analysis of a sample of 829 online Continuous Medical Education (CME) enrolments aimed at inspecting users' preferences and behaviours. The contents of the analyzed course are provided as online SCORM (Sharable Content Object Reference Model) resources together with the corresponding Pdf downloadable versions allowing different usage patterns (online only, Pdf only, online AND Pdf, mixed online OR Pdf). The results point out that there is not a specific preference for one of the four patterns and that most of the users access both navigable modules and Pdf documents. Demographic characteristics and initial knowledge level do not influence the choice of a specific usage pattern that probably depends on internal or context factors. From the point of view of knowledge acquisition, the four patterns are equivalent. As regards users' behaviour, the analysis has pointed out two issues: 1) the attitude to conclude the course in a short time and to reach good test scores, but not the excellence; 2) learning activity tracing data were not available for all the enrolments. Cues for discussion are proposed.

E-learning for occupational physicians' CME: a study case.

The present study reports the results of the evaluation of an e-learning CME course in the field of Occupational Medicine. In particular the following aspects have been investigated: If and how the course contents have met the educational users' needs; The effectiveness of the course in terms of knowledge improvement; Users' behaviour. Attendance data and results of a sample of 1128 attendees have been analyzed via ad hoc developed tools for direct inspection of Moodle CMS database. The results document the effectiveness of the e-learning course, as regards meeting the educational needs of physicians and also the improvement in terms of knowledge and problem solving skill acquisition. Users' behaviour has revealed a certain tendency for passing the tests, more than for pursuing the best possible result. Interaction with the tutor is low.

Earnings in e-learning: knowledge, CME credits or both? Hints from analysis of attendance dynamics and users' behaviour.

Many papers report and convey positive opinion about the use of e-learning in the healthcare sector. The issue is how to exploit at best such a powerful instrument. Starting from data regarding the usage of a CME e-learning course, attendance dynamics and users' behaviour have been inspected with the aim of getting some hints about how to improve the development and the delivery of e-learning courses for CME, and to promote knowledge acquisition at best. The different paths followed by 7811 users have been modeled, from enrolment to conclusion/drop-out, then the behaviour in terms of effort, elapsed time, achieved result have been analyzed. The obtained results point out: good acceptance (retention rate 83%) of a not basic educational model and effectiveness (success rate 79%). At the same time the inspection of behaviour has shown that there is a good margin of possible improvement in terms of knowledge acquisition. Conclusions provide a list of issues to keep in mind during system development, in order to provide CME e-learning meeting both credit and knowledge acquisition goals.

Telemedicine fetal phonocardiography surveillance: an italian satisfactory experience.

In this paper we describe an Italian experience of fetal home monitor, organized using a portable phonocardiography system (product by Pentavox, Hungary), and the method utilized to evaluate its effectiveness in providing quality services and patient satisfaction. Patient satisfaction is an important dimension in the evaluation of quality care delivery. We used phonocardiography technique in our experience of fetal home monitoring as it is non invasive and passive in nature, low-cost and easy to use. A lightweight portable phonocardiograph (Fetaphon-home) was assigned to six selected patients, without effective pregnancy risk to monitor fetal heartbeat, uterine contractions and fetal movements at home or wherever they need it. The selected patients were instructed by trained personnel in the use of the monitoring device. Patients were asked to perform the recording two times a week and to transmit 20-min signal to the reference centre. The home monitoring sessions were performed in addition to the routine surveillance at a gynecologist's office; thus, the home monitoring did not replace clinic visits. The women were requested to fill a satisfaction questionnaire in order to evaluate their quality of life and anxiety state. Preliminary results have shown that home fetal surveillance appreciably reduces the need of travel for patients and consequently their stress. Furthermore, our results suggest that, after a short training, pregnant women are able to record and transmit long traces without troubles. Use of telemedicine system was generally well accepted by pregnant women since it increased the possibility of fetal long-term home surveillance which in turn could increase the efficiency of the service offered to them.

Screen complexity of Italian institutional cancer web sites.

The discordant results of a comparison between calculated and perceived screen complexity of 14 Italian Institutional Cancer Web Sites are described here.

Fractal behaviour of heart rate variability reflects severity in stroke patients.

Non-linear parameters obtained from heart rate variability (HRV) analysis has recently been recognized to provide valuable information for physiological interpretation of heart rate fluctuation. Among the numerous non-linear parameters related to the fractal behaviour of the HRV signal, two classes have gained wide interest in the last years: the beta exponent based on the 1/f-like relationship, starting from the spectral power, and that based on fractal dimension. In order to evaluate the relationship between lesion's severity and fractal behaviour, 20 first-ever stroke subjects and 10 healthy subjects were studied. Patients were divided in two groups according to single or multiple medium cerebral artery lesions. All subjects underwent 24-hour Holter recording analysed by fractal and 1/f-like techniques. Differently from methods usually used in literature to evaluate the fractal dimension (FD), in this work the FD was extracted by using the Higuchi's algorithm that permits to calculate the parameter directly from the HRV sequences in the time domain. Results show that fractal analysis contains relevant information related to different HRV dynamics that permits to separate normal subjects from stroke patients. FD is also able to distinguish between normal and stroke subjects with different lesion's severity.

E-learning for nurse continuous education.

The paper compares the effectiveness of a traditional residential and an e-learning course for nurses, and suggests ways to identify the psychological characteristics which might lead people to prefer e-learning education.

Usage and effectiveness of e-learning courses for continuous medical education.

The paper describes the results of an e-learning experimental project for Continuous Medical Education (CME) in Occupational Medicine in terms of: extent of the e-learning courses usage by the healthcare personnel, knowledge acquisition and satisfaction. 11 courses have been available for 11 months during which 2,034 users all over Italy enrolled in 5,183 courses with a success percentage of 72% and a significant difference between test scores performed before and after attending the e-learning courses. Also user's satisfaction, inspected through a questionnaire, has provided good results. Starting from the experience reported, the authors are confident that e-learning will gain ground and evolve as an effective and appreciated educational mean for CME.

Development of an e-learning system for occupational medicine: usability issues.

The aim of the present paper is to describe the process of developing an e-learning system for continuous medical education in the field of occupational medicine, with special focus on usability. The following steps are described: the needs analysis of the potential users; the prototype of the system that has been set up; the usability evaluation of the prototype by a sample of ten users; the analysis of the potential improvements; the evaluation of the revised system. The results of the usability tests point out that investing in improving usability was useful, even when they have not been recommended as mandatory. Only data collected from real active users will provide a more exhaustive evaluation, nevertheless it can be considered that positive results can be expected.

Usability of institutional cancer web sites: an Italian case study.

In order to evaluate if and to what extent Italian speaking cancer patients can benefit from information available on cancer web sites, an "in vitro" usability (ISO definition) study has been carried out. It investigated the usability of the web sites of the most representative Italian Institutions in the oncological field for the adult patients needing to find information about head and neck cancer. Specific evaluation criteria from the literature were used. The results point out some problems about accessibility, in line with other studies, and about the usefulness of the contents, in particular in the web sites of care delivery institutions: a grey present situation, but there are already grounds for significant improvement. Institutions and organizations must not waste the opportunity of being valuable sources in order to build the so called "informed patient," and the usability of their web sites could make the difference.

The multiple faces of the e-patient, if not disabled.

The term e-health entered common speech a few years ago , while the term "e-patient" has recently appeared on the healthcare scenario. The aim of the present paper is to describe the nature of the so called "e-patient" from different points of view, through a review, not systematic, of the literature. A profile, though not totally exhaustive, of the current e-patient has been drawn, in an attempt to report uncertainties and worries that should not be underestimated. Comments are provided on the asymmetry between the evaluation effort around the internet world and corresponding face-to-face world. Disabled patients are almost excluded from the e-patient family due to the inaccessibility of most of the health related web sites.

Web versus press with a high circulation: an Italian case study.

THE PROBLEM: the quality of health-related information available for general public on the web has been widely debated, often expressing concern, in the last few years, but also other mass media supply medical contents for health consumer. THE OBJECTIVE: To evaluate the quality of information available by the Italian people through Internet in comparison with the one published on the press with a high circulation. A general interest topic such as over-weight and obesity has been identified as a convenient field for the comparison. METHODS: A sample of web sites and articles have been collected--excluding the promotional ones- in order to compare their completeness and correctness. National guidelines were the golden standard. For the web sites, the availability of indications to let the user know the reliability of the site--we will refer to these as "transparency"--has been evaluated through 9 parameters. RESULTS: 45 informative sites and 35 articles have been found: the Italian population has a good chance of getting information. Web sites are much more complete than articles. Correctness of both is quite good. Transparency of web sites leaves much to desire, independently from the quality of the content. LESSON LEARNT: There is probably an excessive confidence about the transparency and caution of articles in dealing with health-related topics. CONCLUSION: The web publishers must necessarily be educated to apply the existing good practice rules, but in the meantime also the press with a high circulation, that is read by a high percentage of people, has to improve its quality in order to co-operate in supplying adequate information. In general, from the traditional exceptionalist approach for medical information on the internet, a definition of media quality standard could be derived.

Using ICNP for nurse electronic charts and protocols in rehabilitation divisions.

The aim of this work is to promote the use of standard terminology for nursing documentation and for nurse protocols' description. We implemented an ICNP browser and we integrated it into two different systems: the nursing electronic patient record and the nursing protocols editor. The former allows nurses to choose ICNP terms for filling the clinical chart, while the latter allows computerising protocols using ICNP terms for the actions specification. Since, in a nursing information system, it should be worth to integrate protocols with the electronic patient record, sharing the same terminology is a crucial issue. We also show how we tailored the information system to the different wards. For each ward, we devised the most frequent patient needs and nursing actions. These lists are used to customise the different interfaces. Finally, by testing the prototype using real-world documents (clinical charts and protocols), we carried out an evaluation of the terminology itself, about its completeness and usability.