E-Nephrology

Diagnosis of renal diseases is often delayed owing to the scarcity of trained physicians, lack of facilities, and shortage of funds limits effective management, particularly when it comes to the red zone of renal replacement therapy. The Internetis expected to open up a myriad resource of knowledge and applications for academicians, researchers and clinicians alike in all health care professions across the globe. Also, the Internet has grown rapidly over the years and will inevitably expand even more. Evolving technologies offer modern applications for information management, communications with multimedia and virtual reality. Now, these innovative technologies have opened up newer possibilities for nephrologists. As Internet is serving as a backbone for these modern technologies, it is an utmost necessity to use and refine Internet applications for future nephrologists. Increasingly easy access to Internet has dramatically reduced barriers in sharing of information among basic and clinical nephrologists. Considering the growing scope for nephrologists in the use of Internet, it is necessary to understand Internet as a source of information and backbone of modern application. This review illustrates expanding roles of the Internet for the nephrologists and provides ready to use compilation of useful academic, research, clinical resources and is expected to introduce, stimulate and guide nephrologists into the realm of the world wide web. It also investigates how Internet is supporting in growth and development of the field of nephrology and present and future scopes of Internet as a tool for professionals involved in this area as well as information about biological sciences, and it also gives information about societies in various continents working in field of nephrology and the links useful for clinicians and research scientists.


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 and similar research networks around the world, which provide reliable, guaranteed bandwidth for high-quality Internet videoconferencing as an alternative to face-toface 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]arching the Web Internet has grown-up into a colossal mass of information, and searching Internet for information requires skills to avoid wasting time and obtain maximum relevant biomedical information.Basically, Internet can be searched for information by using i) crawlers, ii) humancatalogued directories, iii) hybrid search engines, iv) specialized search tools, v) meta search tools and vi) tool bars.Now some specialized search engines are also coming up like Kartoos (http://www.kartoo.com/)which presents results in graphical ma format, while Vivisimo (http://vivisimo.com)presents results as clusters of related terms.Metasearch tools search through different search engines at one time and compare them to find out the best suitable results. [7]All the available search engines have their advantages and disadvantages and should be selected on the basis of specific search requirement.More about search engines can be learnt from websites dedicated to search engine (http://searchenginewatch. com).

Really Simple Syndication
Really Simple Syndication (RSS) is an excellent technology that is being used by nephrologists around the world to keep track of their favorite websites.RSS flips things around a little and is a technology that provides you with a method of getting relevant and up to date information sent to you, for you to read in your own time.It not only saves time but also gets the information quickly after it is published. [8]eb 2.0 Web 2.0 resources impede creativity, collaboration and sharing among users.Integration of Web 2.0 resources allows scientists, students, and medical professionals/ nephrologists to efficiently organize and manage the information and resources that are critical in today's quickly changing biomedical research environment.The recognition of the term Web 2.0, along with the growing use of blogs, wikis and social networking technologies, has led many in academia and business to coin a outbreak of 2.0s, including Library 2.0, Social Work 2.0, Enterprise 2.0, PR 2.0, Classroom 2.0, Publishing 2.0, Medicine 2.0, Telco 2.0, Travel 2.0 and Government 2.0.eTOCs The eTOC service allows anyone who registers their e-mail address to be notified via e-mail when new content goes online.You may choose to receive any or all of the following: notification that a new issue of health information on the Internet is online, complete table of contents for new issues and special announcements from nephrology journals.Virtually, all the key nephrology journals are now available electronically and offer an e-mailed table of contents (eTOC) service whereby nephrologists who register can be notified via e-mail when new content goes online.

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.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
PubMed ( h t t p : / / w w w. n c b i .n l m .n i h .g o v / e n t r e z / q u e r y. fcgi?DB=pubmed): It is a free web-based literature database of National Library of Medicine and includes over 16 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s.It is free and the most highly accessed database.

Scopus ™
(http://www.scopus.com):Scopus provides broad coverage of the sciences and social sciences, indexing 15,000 journals of chemistry, biology, environmental science, mathematics, physics, engineering, health and life sciences, social sciences, psychology and economics.Scopus also provides citation analysis.

EMBASE
(http://info.embase.com/embase_com/about/index.shtml): The Excerpta Medica database (EMBASE) maintained by Elsevier Science, is a major biomedical and pharmaceutical database indexing over 7000 international journals in the fields of drug research, pharmacology, pharmaceutics, toxicology, clinical and experimental human medicine, health policy and management, public health, occupational health, environmental health, drug dependence and abuse, psychiatry, forensic medicine and biomedical engineering/instrumentation.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.

DARE
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].

Nephrology@MedNet
The largest collection of direct links to online medical search engines and databases.Find the Web's free and extensive medical archives, libraries, research databases, catalogs, and statistical data available at educational, governmental and corporate sites.CyberNephrology E-mail discussion group for parents of children with kidney disease.cyberNephrology  provides this website for the purpose of rendering online services, providing useful information and spreading knowledge (http:// www.cybernephrology.org/).

iKidney.com
Nephrology pediatric educational material but no chat room.iKidney has been selected as a featured site in Lightspan's StudyWeb ® as one of the best educational resources on the web.StudyWeb ® is an educational resource site for students and teachers that select only the important informative websites (http://www.ikidney.com/).

Kidney Patient Guide
For kidney patients and those who care for them (http:// www.kidneypatientguide.org.uk/site/contents.php).

CROWNWeb
The Centers for Medicare and Medicaid Services is developing a web-based application, Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb), which is designed to facilitate data entry, updating, and retrieval for dialysis facilities nationwide.Part 1 of this three-part series outlines the history of end-stage renal disease and Medicare, and covers the rapid growth of ESRD (End stage renal disease) data management as well as other events that require progression to an online data collection and management system. [11]Ncode Health on the Internet Foundation Code of Conduct (HONcode) for medical and health websites (http://www.hon.ch/HONcode/index/html) specifies eight principles to direct website developers in basic ethical standards and discover that consumers know the source and rationale of the data they are reading.To assist consumers use and comprehend medical terminology, the Medical Library Association (MLA) has published a brochure entitled ''Deciphering Medspeak'' which is offered free of charge in individual copies by sending an e-mail to info@mlahq.org or visiting the MLA website at http://www.mlanet.organdfor bulk orders the e-mail has to be sent to mlafa@ mlahq.orgThe MLA has provided a ''top ten'' list of most useful consumer health websites.[12]

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.fprot.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]nchanda and Bid: Internet and nephrology 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.
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 (http://www.york.ac.uk/inst/crd/crddatabases.htm):