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Lancet, Volume 361, Number 9373 07 June 2003

Just-in-time lectures: SARS

With the emergence of Severe Acute Respiratory Syndrome (SARS), an enormous
public-health effort is needed to limit further spread of the infection. As of
May 19, 2003, SARS has spread to potentially 30 countries, in five continents,
causing 7864 cases and 643 deaths since the initial cases were identified
when they peaked in late February, 2003. The actual outbreak was later identified
to have occurred in Guandong Province, China, in November, 2001. At present
the overall case-fatality proportion is 82%, but has considerable variation
across countries, ranging from 55% (289/5236) in China to 164% (23/140) in
Lack of information and knowledge about a global outbreak such as SARS makes
all affected people vulnerable, especially health professionals who need
accurate and up-to-date information to care for patients and undertake crucial
research. Advances in information technology, however, have meant that health
information can be rapidly accumulated and disseminated through the internet to
the global medical community. The wide accessibility of this medium means that
Just-in-time (JIT) lectures, which target educators, can help to improve the
dissemination of information in a health crisis.
The concept of JIT lectures comes from manufacturing, where JIT inventory
control achieved huge savings and flexibility. When applied to medicine, the
basic idea of JIT lectures is that new information about a disease presented in a
structured format (using PowerPoint) can be disseminated instantly. The beauty
of JIT lectures is the speed with which critical lectures can be written and
distributed. The widespread use of computing in health-care systems enhances
the flow of information over the internet. Moreover, the capture-recapture
epidemiological tools used for Global Disease Telemonitoring can assist in
computing accurate incidences of diseases.2,3 Thus, JIT lectures can be sent around
the world in a matter of minutes.
In the event of a health catastrophe, experts can be asked to create
background lectures on the epidemiology of the disease, as well as lectures that
describe events as they unfold. Information from scientific journals can also be
compiled together with the most current reports from affected hospitals.
Moreover, experts can continuously update JIT information as new events unfold. These
lectures should focus on a single disease, such as SARS, or on an event, such
as a natural or human catastrophe. The processing of the JIT lectures needs
to be quick to maximise their rapidly decaying shelf-life. As a source of
accurate current information, JIT lectures attract the attention of not only the
medical community, but also the media and listservers, such as ProMED (Program
for Monitoring Emerging Diseases), as has been the case with SARS.
The value of JIT lectures was tested during the SARS outbreak. A request went
out to subscribers of the Supercourse Newsletter (http://www.pitt.
edu/~super1/) and there was a huge international response. The first lecture on SARS by
Rashid Chotani went on the University of Pittsburgh, Supercourse website on
April 18, 2003 (panel). The response from the internet community was incredible.
Subsequently, other lectures were uploaded and the traffic on the website
increased; requests for downloading the lectures came from all over the world,
including remote parts of China, India, Thailand, and Korea, as well as from
Europe and the USA. Many people contacted the website for more information.
JIT lectures are a viable educational tool and can provide much needed
information any time, anywhere, to the global community in a very short time. The
JIT SARS lecture through the Supercourse website has been used worldwide. This
spread of knowledge and information provides intervention strategies to
educators to help them respond to chaotic situations. JIT lectures can reduce fears
and help health professionals make informed decisions using accurate
1 WHO. Cumulative number of reported probable cases of severe acute
respiratory syndrome (SARS). 2003_05_19/en/;
accessed May 19, 2003.
2 LaPorte RE, Gooch WA, Gamboa C, Tajima N. International disease counting
form. Lancet 1993; 342: 930-31. [PubMed]
3 WHO Directors of Non-Communicable Disease Collaborating Centers and Key
Officials. Needed: universal monitoring of all serious disease of global
importance. Am J Pub Health 1993; 83: 941-43. [PubMed]
*Rashid A Chotani, Ronald E LaPorte, Faina Linkov, Sunita Dodani, Danyal
Ahmed, Khan M Ibrahim
*Global Infectious Disease Surveillance and Alert System, School of Medicine
and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
21205, USA (RAC, DA); University of Pittsburgh, Pittsburgh, PA, (REL, FL);
Aga Khan Medical University, Karachi, Pakistan (SD); and Bielefeld School of
Public Health, University of Bielefeld, Germany (KMI)