The Anesthesiology Discussion Group (1995)

We have created an international anesthesiology and critical care medicine discussion group that uses Internet electronic mail to allow rapid exchange of ideas while requiring only minimal computer skills. This discussion group is potentially of value to all members of the anesthesia care team because it provides a forum for exchange of new ideas and information about clinical issues and practice patterns from around the world. Researchers, academicians, and private practitioners who have joined the discussion group use it to discuss matters of scientific, clinical, and regulatory interest. Any individual with a professional interest in anesthesiology can participate in the Anesthesiology Discussion Group. All that is required is a computer with a direct connection to the Internet, or a computer equipped with a modem and access to a commercial on-line service (e.g., CompuServe Registered Trademark, American OnLine Registered Trademark, or Prodigy Registered Trademark) that provides Internet electronic mail. The Internet is a global network supported in part by the National Science Foundation and other United States government organizations [1]. It joins thousands of computer networks and allows rapid transfer of information via file transfer and electronic mail or recently developed browsers such as the Internet Gopher and the World Wide Web. Internet users have access to an extensive collection of computer programs and information on a wide variety of topics, as well as access to computer services throughout the world. The Internet has made it practical to exchange information with individuals around the world, frequently within a matter of minutes. This capability can be used to create a forum of discussion to help anesthesiologists make contact with colleagues and keep current on subjects of interest [2]. Thousands of discussion groups, which allow individuals with a common interest to share ideas, have evolved on the Internet. The Anesthesiology Discussion Group uses electronic mail as its medium because it is presently the simplest way to communicate across the Internet. The immediacy of electronic mail makes it feasible to pose a question about a specific patient or clinical scenario and have it answered within a few minutes. The discussion group was started on May 1, 1993, and announced in a letter to the editor that was published in Anesthesiology in October 1993 [3]. Mailing List Processor The Anesthesiology Discussion Group currently resides on a Sun SparcStation LX (Sun Microsystems, Berkeley, CA) with 1.0 gigabytes of hard disk space and 32 megabytes of RAM. The list processor [4] runs under SunOS 4.1.3. The workstation is connected to the Internet through New York University's campus-wide network. The workstation and list processor operate continuously to automatically process posted messages and requests for subscriptions to the list. A list member can send a message to the entire group by addressing it to the list server. The list processor then automatically forwards this message to all subscribers. Replies can be sent either directly to the original sender or to the entire list. Messages sent to the list are automatically saved and added to a monthly "digest." These digests are made available to any list subscriber via either the Internet Gopher or File Transfer Protocol. The list server provides a list of current subscribers at the request of any member. The mailing list services are provided free of charge to any person with a professional interest in anesthesiology. The mailing list is operated with the support of the New York University Department of Anesthesiology. The cost of startup and maintenance of the list was limited to the purchase of the workstation ($6,000) because the necessary infrastructure (i.e., Internet access through New York University's campus-wide network) was already in place. The computer and mailing list is maintained by one of the authors (K.J.R.). List Server Statistics The list currently has 850 subscribers. Two to three new subscribers are added to the list per day. A total of 127 requests to be removed from the list have been received. The frequency of postings varies widely depending on the subjects being discussed. Table 1 lists the number of posts to the list by month for 1 yr. Approximately 10 messages per day are currently posted. The list server log reveals a characteristic pattern of subscriptions: One person from a given department generally subscribes to the list. Several days later, additional subscription requests are frequently received from the same institution.Table 1: Number of Posts by MonthTopics of posted messages have included questions and comments about scientific, clinical, administrative, and regulatory issues. Calls for papers and announcements of scientific meetings have been posted. Officials from the Food and Drug Administration (FDA) use the list as an additional medium for distribution of urgent notices about drug and equipment recalls and to answer questions about FDA policies and regulations. The FDA has also used the list to solicit opinions from the anesthesia community prior to taking regulatory action (Bedford R: Spinal 5% Lidocaine (Anesthesiology Discussion Group Posting) 8 March 1994. Available Gopher: gasnet.med.nyu.edu/Digests of the Anesthesiology Discussion Group/94-03.txt). Hospital and departmental administrators have subscribed to the list and regularly solicit opinions on various subjects related to operating room management. Summaries of list discussions have also been presented to administrators by physician subscribers. These summaries have been used to help formulate institutional policies on such subjects as transfusion, postoperative analgesia, and operating room design. Requests for advice on the management of specific patients are also posted. Recent topics of discussion have included the intraoperative management of a patient with epidermolysis bullosum and peripartum management of a patient with a spinal cord arteriovenous malformation. The elapsed time between a message and its response varies depending on the topic and the time of day that the message is posted. A controversial statement might bring a response within minutes. Figure 1 shows the subject, date, and time of a typical post and the replies to it that were posted over the next 48 h. Table 2 is a list of subjects of all messages posted during 1 mo.Figure 1: The first 48 h of a discussion thread. The initial message was a request for a substitute for intravenous hydralazine. The ensuing discussion produced a total of 44 messages.Table 2: List of Subjects of Each Message Posted During 1 Mo and the Number of Postings Under Each SubjectDiscussion Data from the list server log and the monthly digests suggest that the Anesthesiology Discussion Group is a valuable form of communication for physicians and others with an interest in the field of anesthesiology. The fact that one subscription from a department was usually followed by additional subscriptions from the same department suggests that news of the list had spread through the department at that institution, and other members of the department became interested and subscribed. The most pessimistic view of the 127 cancellation requests is that 20% of the subscribers left the list. Some of these requests may, however, represent a user moving to a different electronic mail address or cancelling the subscription during a vacation or leave of absence. This is supported by the fact that many of the subscribers who cancel reappear on the list from a new location or from the same location several weeks later. Furthermore, the list continues to grow with new subscriptions and sustained activity by those who have maintained their subscription. The Anesthesiology Discussion Group has, even at this early stage in its evolution, already had an impact on both education and patient care. Topics raised on the list have been discussed as part of formal teaching exercises by several departments of anesthesia around the world (Yoel Donchin, MD, Department of Anesthesia, Hadassah University Hospital, Jerusalem, Israel, and Per Foege Jensen, MD, Department of Anaesthesiology, Herlev University Hospital, Denmark; personal communication, 1994). A number of list subscribers have made decisions based on information provided by the mailing list. Of course, a decision affecting patient care based on information from the discussion group should be made with caution since the discussions are not moderated, nor are they subject to peer review. The issue of legal liability for opinions posted to the list has yet to be resolved. Physicians answering questions related to patient management tend to provide references, however. A list of this type may be particularly valuable when caring for a patient with a rare coexisting disease, because the list draws from a large pool of physicians who may have cared for a similar patient, and would therefore be able to offer practical advice. Medical information is most commonly disseminated in the form of journal articles, books, conferences, and panel discussions. The Anesthesiology Discussion Group does not replace these traditional forms of communication, but augments them. It provides an interactive, worldwide "town meeting" that can be used for informal discussion. The interactive nature of the discussion group differs from other methods of electronic dissemination of information. Tools such as the Internet Gopher and the World Wide Web are designed to provide information; the user interacts with a computer. The discussion group allows all of its members to interact with each other. Access to the Internet is becoming widely available as a result of the proliferation of inexpensive personal computers and on-line computer services. The National Science Foundation has instituted policies that call for extension of access to the Internet to public schools, libraries, hospitals, and other nonprofit institutions. This service is usually provided at no cost to individuals in academic institutions and is now available to nonacademic users through on-line services. The activity on medical discussion groups on commercial services and the growing interest in the Internet [5] suggest that interest in electronic means of communication is increasing. Other medical specialties have started to use the Internet to provide educational resources, providing such resources as an on-line repository of radiology teaching files [5,6]. The Anesthesiology Discussion Group is one of the earliest applications that use the Internet to provide a practical tool for anesthesiologists. There are currently five other anesthesiology discussion groups: an anesthesiology group on CompuServe Registered Trademark's Medical Forum, a pediatric pain mailing list (Canada), an anesthesiology mailing list that existed prior to this list (Buffalo, NY), and a neurosurgical anesthesia list (San Francisco, CA), a Critical Care mailing list (Pittsburgh, PA), and an Australian anesthesiology list (Queensland, Australia) which were created after this list was formed. As this form of communication evolves, it is likely that other subspecialty groups will form their own, more focused mailing lists. Future applications of this technology include multimedia anesthesia manuals, electronically published bibliographies, and electronic case reports of patients undergoing unusual procedures or with unusual diseases. Still pictures, animated video, and sounds can be stored on a computer and transferred rapidly over a computer network. A multimedia textbook stored on one or more central computers can be accessed from anywhere in the world and updated continuously to reflect the state of the art. It can use pictures, sound, and video clips to help describe a murmur or demonstrate a new regional anesthetic technique. A peer-reviewed, electronic journal of anesthesiology that focuses primarily on educational topics is being jointly published by one of the authors (K.J.R.) in cooperation with an anesthesiologist at the University of Toronto [7]. Recent advances in networking technology, sharp decreases in computer prices, and easy-to-use computer programs have made access to the Internet feasible for anyone with a computer and a modem. The early success of this mailing list suggests that this method of communication is of benefit to researchers, academicians, and anesthesiologists in private practice. Appendix To subscribe to the Anesthesiology Discussion Group, send a message to [email protected] The only line of text in the message should be: subscribe anesthesiology [your name] You will receive information about the group and instructions for posting messages by return mail. Questions or comments about the list should be directed to [email protected] The addresses above are Internet addresses. If you subscribe to a commercial service such as MCI Mail Registered Trademark or CompuServe Registered Trademark, ask your service's customer service department how to send electronic mail to the Internet.