E-Nephrology

Introduction

The Internet is set to be in the forefront of the new age of technological revolution. With the explosive growth of the World Wide Web in recent months, health and medical websites are evolving. The Internet is a colossus body of information, which has, in recent years, witnessed an amazing expansion to such an extent that colloquially it is now termed as the “information superhighway.” There has been an enormous increase in the amount of information available through the Internet over the recent years. With an estimated 320 million web pages available,[1] it has emerged as the most powerful platform for exchange of scientific knowledge.[2]

Nowadays, Internet has become one of the most common media to explore and extract information of interest for researchers in any field, including nephrology. Its power is most strongly seen among scientists, as more and more information is made available through “the Net,” whether it is gene sequences, experimental data, chromosome maps or complete journal articles.[3] Its influence is most strongly felt among basic scientists and clinicians as more and more information is coming on “the Net” in the form of e-journals, e-books, research articles, gene sequences, experimental data or chromosome maps.[4] In the past few years, many Internet and nephrology resources have been posted on the web, including medical journals, medical associations, clinical trial registries and medical guidelines. Solze et al[5], have discussed in their review about online texts and web resources that are, in many respects, ahead of other areas of medicine and websites which provide free full-text access to medical journals and books in poorer countries: the Global Health Network Supercourse, which provides specially designed online lectures for the developing world, and Internet2/Abilene and similar research networks around the world, which provide reliable, guaranteed bandwidth for high-quality Internet videoconferencing as an alternative to face-to-face lectures and meetings for nephrologists.

Origins of the Internet

Internet originated as a defense computer network (ARPANET) initiated by ARPA of US Defense, later known as Defense Advanced Research Projects Agency (DARPA). This ARPANET grew into different phases of development open architecture format with modified protocols and finally developed into the present day Internet, creating the WWW as a platform for exchange of information between geographically separated computers. The Internet and WWW (also called W3 and the Web) have morphed into a sort of tool for retrieval and disposal of scientific and other literature for the advancement of education. It is Internet’s most exciting and popular development. As Internet matured into global treasure of ever growing knowledge, it touched all spheres of life. A list of few common websites has been recently reported by Konwar et al [Table 1].[6]

Nephrology and Internet

Internet has provided an interactive forum for the researchers and clinicians working in nephrology

A large and rapid growing volume of biomedical information can be accessed through the Internet. There are many databases available on Internet that may be very useful not only to the nephrologists but also to the people from other streams. At present, numerous biomedical databases of journals are accessible in Internet which include index of journal citations and abstracts of articles and even links to full text articles. Table 2 enlists few of the preferred sites for searching scientific literatures in nephrology. Some professional organizations related to nephrology are listed in Table 3 which helps not only the basic researcher but also clinical nephrologists.

An e-book is an electronic or digital version of a book. This version of book is predicted to be the future version of books as it is easier to read, requires less space and is easy to browse through and jump to relevant paragraph immediately. Internet has already become a major platform for assessing these books. Few sites allow free browsing and reading of books. While most are restricted to paid members only, some only provide CD-ROM of the book. Table 4 enlists few website of e-books related to nephrology and medicine. Training of nephrologists in advance centers would give them great advantage to explore and learn new technologies; therefore, we have also listed different agencies providing fellowships for advance training for nephrologists [Table 5]. For Indian nephrologists and nephrology-related patients, Table 6 gives useful information on nephrology-related websites of universities, medical centers and government agencies in India.

A. Nephrology Journals and Article Search

B. Chronic Kidney Disease and Web

The WWW is now considered a key source of health information; but the quality and utility of this information has been challenged. Calderón et al.[10] have reported on the structural, content, and linguistic barriers for the access of the chronic kidney disease (CKD) information and discuss the implications of limited Internet access to communicating health. Technical (number of hyperlinks), content (number of six core CKD and risk factor information domains included) and linguistic barriers were assessed for websites offered by 12 kidney disease associations.

C. Renal Transplantation and Web Resource

The last decade has seen an exponential rise in the amount and the nature of information that is available on the Internet about renal transplantation. We have described useful web links for detailed information related to kidney transplant [Table 7] and provided links of important agencies which provide financial support to the nephrology patients, especially dialysis and kidney transplant patients [Table 8].

D. Useful Nephrology Links

Database of Individual Patients’ Experience

Database of Individual Patients’ Experience (DIPEx) is a new Internet-based multimedia resource that provides access to the experiences of others who have faced similar health dilemmas. On the DIPEx site, anybody can watch video clips, listen to the voices or read the accounts of people relating their experiences of illness and the impact it had on their lives. We can also find out about an illness and its available treatments, and find links to support groups and other reliable sources of medical information. DIPEx aims to promote more balanced encounters between patients and health care professionals by providing detailed access to the patient perspective. It is, at once, a 24-h support group for anyone whose life is touched by an illness and a valuable resource for the training of doctors, nurses and other health professionals and health workers.

Home dialysis center (http://www.homedialysis.org/resources/stories/) is a very useful site for nephrology patients to obtain important and critical information regarding their future care.[13]

Patient Stories and Experiences and Their Impact on Other Patients and Health Professionals

Internet (e-patients.net) is a very powerful tool for search and retrieves information from stories of other patients. With a “story topics search” facility, participants are better able to find the information they are looking for. Also, they retrieve stories that more closely covered, their information needs and they learn more from the stories retrieved.[14]

Challenges and Limitations

Reliability, discretion and security are the major concerns for application of Internet in nephrology. Various antiviruses like Norton-Antivirus (www.symantec.com), f-prot (www.f-prot.com), Thunder-BYTE (http://www.thunderbyte.com/), McAfee (http://www.mcafee.com) are available, which can be effectively utilized not only for repairing infected programs but also checking virus entry and enhancing cyber security. With a rise in numerous of health care websites, clinicians and patients have more information than ever to wade through, even simply the volumes of information it contains can be exhausting to search out for specific need. Unfortunately, many of these sites contain incomplete, misleading, or difficult to understand information, while others blur the distinction between advertising, medical advice and simple disclosure of fact.[15]

At present, spurious health care websites have outnumbered the trustworthy ones, commonly that of universities, medical centers, government agencies, etc. Some patients consider online consultations as substitutes for a physician’s visit, ignoring the disclaimers that the Internet information is not a substitute of medical practices. Therefore, in order to prevent the spreading of wrong information as well as making the user aware of these sites, the management of quality and reliability of medical information on Internet is extremely important. A possible solution could be labeling of medical information websites by web authors. Labeling and filtering technologies such as platform for Internet content selection (PICS) can help separate valuable health information from doubtful information. Further, doctors, medical societies and related people can critically evaluate Internet information by putting electronic evaluative and descriptive “tags” on it. Table 9 provides more insight to check the authenticity of information and focuses upon health misinformation, fraud and quackery as public health problems.