Pediatric Informatics: Computer Applications in Child Health (Health ...

138 D.M. D’Alessandro
4. Case series or poor quality cohort/case control studies
5. Expert opinion = worst
Recommendations are based on consistency among research studies:
A. Consistent Level 1 studies = best
B. Consistent Level 1 studies or extrapolations from Level 1 studies
C. Consistent Level 4 studies or extrapolations from Level 2, 3 studies
D. Level 5, inconsistent or inconclusive studies = worst
This system or modifications are often used (e.g. National Cancer Institute’s PDQ ®
Cancer Information Summaries, http://www.nci.nih.gov/cancertopics/pdq), but it
can be cumbersome to remember particularly because of sublevels of the validity
scale (Ex: a Level 1c). Some authors opt to make a summary statement (Ex: “data is
based upon literature analysis and expert panel consensus,” e.g. National Guideline
Clearinghouse, http://www.guideline.gov). What is most important for clinicians to
know is the type of evidence recommendations upon which they are based.
10.5.2 The Internet and Information Quality
The Internet was originally developed in 1969 as a means of improving communications
among defense researchers (i.e. ARPANET). In the 1980s and 1990s software
tools such as Gopher, WAIS, and the FTP Archive list 36 were used to organize
online information. In 1992, the World Wide Web (or the Internet) was developed
and revolutionized communication and information access. The Internet is a massive
information resource and ~ one billion people (1/6 of the world’s population)
have used it. The Internet is estimated to have grown ~190% in the past 5 years. 37
There are no published data of the size of the pediatric Internet, but a monitored
subset of it grew 135% in 2001–2002 (D’Alessandro DM, unpublished data).
The World Wide Web facilitated the creation, distribution, and linkage of EBM
resources through digital libraries for answering questions and solving problems.
The first Internet-based medical digital library was the Virtual Hospital ® from
the University of Iowa which was developed in 1992. The National Library of
Medicine’s digital library followed soon afterward in 1993. The pediatric component
of the Virtual Hospital was reorganized into the Virtual Children’s Hospital in
1997. An associated example of a pediatric digital library is GeneralPediatrics.com
(http://www.generalpediatrics.com) 38 (see Specific Resources below).
Determination of the quality of health information on the Internet information
has been studied. 39,40 Standards to denote integrity of online material
include display of authorship, reference, sponsorship and/or ownership and
currency (e.g. Health on the Net, www.hon.ch). Some Websites also use traditional
peer-review where individuals or small groups review information prior
to publication (e.g. Cochrane Collaboration, http://www.cochrane.org/). Other
Websites use an accredi tation model designed to judge works that change over