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PubMed1999

Testing a multimedia module in cancer pain management.

BACKGROUND: The technologies for providing better pain management for cancer patients are widely available, but barriers still exist that prevent their optimal use. One of the most important barriers is a knowledge deficit among primary care physicians in adequate pain assessment, in opioid pharmacology, and in the importance of an interdisciplinary approach to the management of pain. METHOD: The authors prepared a CD-ROM multimedia cancer pain management module to overcome the physician knowledge barrier. RESULTS: Tests of the module with primary care physician and primary care resident volunteers indicate that the cancer pain management multimedia module meets its educational objectives.

Arkansas↗
PubMed2001

The use of a multimedia risk analysis approach in designing waste management strategies.

A pollution source may release residuals to any of several environmental media, depending on the process design and control strategies. These residuals then are subject to transfer, transport, and transformation within the interconnected compartments of the environmental system. The exposure and susceptibility of people and other receptors to pollutants are different in these various media, and so that risks imposed will vary according to the fate of the pollutants in the system. Because of interactions between compartments in the system, a single-medium approach to environmental management that mitigates problems in one environmental medium at a time independently of risk through other media may not minimize the aggregate risk a receptor receives from all pathways. Alternatively, a multimedia approach advocates focusing on the full environmental system providing pathways for exposure and selecting risk management strategies based on minimization of the aggregate and cumulative risk from all pathways and all compounds. This study combines multimedia risk analysis and an optimization framework to examine a methodology for selecting waste treatment/disposal and pollution control measures, applies the methodology to a sludge management decision problem, and considers the implications for continued use of single-medium analyses.

Decision Making↗
PubMed2003

Emission and fate assessment of methyl tertiary butyl ether in the Boston area airshed using a simple multimedia box model: comparison with urban air measurements.

Expected urban air concentrations of the gasoline additive methyl tertiary butyl ether (MTBE) were calculated using volatile emissions estimates and screening transport models, and these predictions were compared with Boston, MA, area urban air measurements. The total volatile flux of MTBE into the Boston primary metropolitan statistical area (PMSA) airshed was calculated based on estimated automobile nontailpipe emissions and the Universal Quasi-Chemical Functional-Group Activity Coefficient computed abundance of MTBE in gasoline vapor. The fate of MTBE in the Boston PMSA was assessed using both the European Union System for the Evaluation of Substances, which is a steady-state multimedia box model, and a simple airshed box model. Both models were parameterized based on the meteorological conditions observed during air sampling in the Boston area. Measured average urban air concentrations of 0.1 and 1 microg/m3 MTBE during February and September of 2000, respectively, were comparable to corresponding model predictions of 0.3 and 1 microg/m3 and could be essentially explained from estimated temperature-dependent volatile emissions rates, observed average wind speed (the airshed flushing rate), and reaction with ambient tropospheric hydroxyl radical (*OH), within model uncertainty. These findings support the proposition that one can estimate gasoline component source fluxes and use simple multimedia models to screen the potential impact of future proposed gasoline additives on urban airsheds.

Air Pollutants↗
PubMed1996

"Robo-Rad": an inexpensive user-friendly multimedia report system for radiology.

BACKGROUND AND PURPOSE: The complex information obtained by CT, MR, and ultrasound examinations is often difficult to convey with a written report. Today's multimedia computer technology provides a medium within which the audio and the visual components of a radiologic consultation can be made available simultaneously, with the projected capability of remote access from any personal computer. A system was developed to run on low-end computer systems with image quality adequate for reporting purposes and prudent memory management (each report occupies < 4 MB). With this system-"Robo-Rad"-the image and radiologist are recorded simultaneously while he or she describes and points out (with a mouse) areas of interest. This dynamic report, along with patient data, can be retrieved and viewed by the consulting physician at his/her convenience using a low-end PC or Macintosh computer. MATERIALS AND METHODS: To assess the clinical utility of Robo-Rad, survey responses were solicited from clinical physicians at the Penn State University Hospital (41.5% faculty/fellows, 31.7% residents, 11.8% medical students, 2% clinical nursing; n = 101) during a hands-on demonstration using studies of 35 consecutive inpatients whose CT scans had been dictated into the system. RESULTS: In an average week, the surveyed professionals ordered 3.2 +/- 3.0 CT studies, reviewed 3.8 +/- 3.0 CTs, spent 1.5 +/- 2.0 hours locating Ct studies, and discussed 2.3 +/- 1.9 CT cases with a radiologist. The average time spent discussing a single CT case with a radiologist was reported as 9.4 +/- 5.9 minutes. On a five-point rating scale (1 = not at all to 5 = very much so), respondents indicated that the Robo-Rad report was helpful (4.3 +/- 0.7) and provided clinically important information that would be difficult to convey with current dictation systems (4.2 +/- 0.8). Desire to discuss the case with a radiologist in addition to viewing the Robo-Rad report scored 3.2 +/- 1.0. If such a system were readily available, 91.8% of the respondents indicated that they would use it in addition to the currently available written report and audio dictation system, and 96.6% would use it instead of the current system. Local area network and modems were the modalities of highest interest for remote access (69.3% and 44.6%, respectively). CONCLUSIONS: Judging by these data, the Robo-Rad system would be of benefit to clinicians. It provides a user-friendly, low-cost multimedia radiology report utilizing readily available technology to improve radiologist-clinician communication.

Attitude of Health Personnel↗
PubMed1999

Multimedia electronic medical record systems.

A wide range of imaging technologies are becoming increasingly important to the practice of medicine. In addition, many medical specialties are highly visual, independent of their use of new imaging modalities. Because today's medical record contains text, images, and physiologic signals, it is inherently multimedia in nature. However, most electronic medical record systems handle only the textual portion of the patient record, resulting in a fragmentation of the database that physicians need to make timely, effective clinical decisions. Advances in database-, storage-, data-compression, and networking technologies will facilitate the development of multimedia electronic medical record systems for the 21st century. These systems will become widely used over the next decade, and in addition to enhancing patient care, will also present new opportunities for using clinical imaging data for biomedical research and education.

Forecasting↗
PubMed2003

Development of a reliable multimedia, computer-based measure of clinical skills in bedside neurology.

PURPOSE: This study reports the development of reliable multimedia, computer-based measures of bedside neurology skills. METHOD: A consortium of neurologists and medical educators (1) identified bedside skills and (2) created a computer-based test. Test-item stems were multimedia clips of standardized patients. Options appeared as text. Sixty-one junior medical students responded to these items. RESULTS: The 77-item test yielded a reliability coefficient of 0.85. Subgroup item analysis resulted in reliability coefficients of 0.73 for the 20-question "pretest" (Test A) and 0.75 for the 20-question "posttest" (Test B). CONCLUSION: Two sets of test items were developed that can be used as outcome measures in studies that assess the effectiveness of educational interventions in bedside neurology.

Clinical Competence↗
PubMed2000

Multimedia computer database for neurosurgery.

OBJECTIVE: There is a need for an efficient mechanism of storing and analyzing neurosurgical clinical, imaging, and operative data to facilitate clinical audit, research, education, and preparation of scientific presentations. METHODS: A computer database was developed to meet this need. The recorded data include diagnoses, digitized neuroimaging studies, operative details (with intraoperative video clips), transcranial Doppler studies, outcomes, complications, admissions, and clinic visits. The anatomy, pathology, and clinical presentation are recorded for each diagnosis. RESULTS: The database provides an audit of neurosurgery cases, which includes admission Glasgow Coma Scale score, length of intensive care and hospital stays, Glasgow Outcome Scale score, and complications. Clinical research is facilitated by flexible search strategies based on the anatomy, pathology, or clinical presentation of diseases, or any of the recorded intraoperative or outcome factors. The system can be used to assess the influence on outcome of factors, such as transcranial Doppler velocity, intraoperative blood pressure, and the use of ventricular drainage, intraoperative angiography, or temporary clipping. The database can be used to track patients with untreated or partially treated conditions, such as incidental or incompletely coiled aneurysms. The recorded images and video clips are used for teaching and producing multimedia presentations and reports. The database is designed to enable secure Internet connections among institutions so that outcomes and complications can be compared among surgeons and institutions. CONCLUSION: This multimedia computer database facilitates clinical audit, research, teaching, and presentation activities.

Databases, Factual↗
PubMed2004

Exploring the self-learning experiences of patients with depression participating in a multimedia education program.

The purpose of the present study was to explore the self-learning experiences of depression patients on interactive multimedia education program. Qualitative in-depth interviews were employed. Fourteen patients with a first episode of major depression were recruited from a psychiatric outpatient department. Explanations of the purposes of the exercise and on-the-spot teaching were provided by the researcher before the study began. A tape-recorded, semi-structured interview format was employed after two weeks. Data analysis was performed in the framework of line-by-line content, contextual and thematic analysis. Eight subjects successfully completed the entire learning activities. Content analysis revealed 4 main aspects of successful self-learning experiences: the triggering of learning motivation, the enjoyment of self-paced learning, support for the effects of learning materials, and the gaining of self- awareness and changes. The factors influencing learning performance were related to: environmental impact, the degree of familiarity with traditional learning, possession or non-possession of the necessary computer operation skills, and good computer support. However, the findings provide a preliminary understanding of the application of interactive multimedia education programs in terms of self-learning outcomes and recognizing key elements of learning impediments among the study sample. A larger sample size with different clinical contexts is recommended to determine the effect and generalizability for future research. Furthermore, the creation of a computerized learning environment with different educational styles is crucial to patients' success in obtaining depression-related information and understanding effective adaptive skills.

Adaptation, Psychological↗
PubMed2006

The semantic pathfinder: using an authoring metaphor for generic multimedia indexing.

This paper presents the semantic pathfinder architecture for generic indexing of multimedia archives. The semantic pathfinder extracts semantic concepts from video by exploring different paths through three consecutive analysis steps, which we derive from the observation that produced video is the result of an authoring-driven process. We exploit this authoring metaphor for machine-driven understanding. The pathfinder starts with the content analysis step. In this analysis step, we follow a data-driven approach of indexing semantics. The style analysis step is the second analysis step. Here, we tackle the indexing problem by viewing a video from the perspective of production. Finally, in the context analysis step, we view semantics in context. The virtue of the semantic pathfinder is its ability to learn the best path of analysis steps on a per-concept basis. To show the generality of this novel indexing approach, we develop detectors for a lexicon of 32 concepts and we evaluate the semantic pathfinder against the 2004 NIST TRECVID video retrieval benchmark, using a news archive of 64 hours. Top ranking performance in the semantic concept detection task indicates the merit of the semantic pathfinder for generic indexing of multimedia archives.

Abstracting and Indexing↗
PubMed2001

Using a multimedia tool to improve cardiac auscultation knowledge and skills.

OBJECTIVE: Today's medical school graduates have significant deficits in physical examination skills. Medical educators have been searching for methods to effectively teach and maintain these skills in students. The objective of this study was to determine if an auscultation curriculum centered on a portable multimedia CD-ROM was effective in producing and maintaining significant gains in cardiac auscultatory skills. DESIGN: Controlled cohort study. PARTICIPANTS: All 168 third-year medical students at 1 medical school in an academic medical center. INTERVENTIONS: Students were tested before and after exposure to 1 or more elements of the auscultation curriculum: teaching on ward/clinic rotations, CD-ROM comprehensive cases with follow-up seminars, and a CD-ROM 20-case miniseries. The primary outcome measures were student performance on a 10-item test of auscultation skill (listening and identifying heart sound characteristics) and a 30-item test of auscultation knowledge (factual questions about auscultation). A subset of students was tested for attenuation effects 9 or 12 months after the intervention. RESULTS: Compared with the control group (1 month clinical rotation alone), students who were also exposed to the CD-ROM 20-case miniseries had significant improvements in auscultation skills scores (P < .05), but not knowledge. Additional months of clerkship, comprehensive CD-ROM cases, and follow-up seminars increased auscultation knowledge beyond the miniseries alone (P < .05), but did not further improve auscultation skills. Students' auscultation knowledge diminished one year after the intervention, but auscultation skills did not. CONCLUSION: In addition to the standard curriculum of ward and conference teaching, portable multimedia tools may help improve quality of physical examination skills.

Analysis of Variance↗
PubMedDate not supplied

Development of interactive patient-based multimedia computer programs in veterinary orthopedic radiology.

Three computerized multimedia programs on large and small animal veterinary orthopedic radiology were developed and implemented for the radiology curriculum as an alternative to traditional film-based laboratory learning. Programs utilized "hot words" (colored text words that displayed an overlaid image label that highlighted lesions) and interactive quizzes which responded appropriately to selected answers. "Hot words" helped students develop confidence in accurate lesion detection and the interactive quizzes transformed learning from a passive to an active process. Multiple examples were provided for reinforcement and concepts were incorporated from other clinical disciplines for curriculum integration. Programs were written using a presentation software program, Toolbook for DOS based platform, and contained radiographic images made by laser-scanning digitization. Multiple students could simultaneously access the programs through a network server. These pilot programs were implemented successfully and computerized multimedia presentation proved to be well suited to teaching radiology. Development of the programs required attention to a number of hardware, software, time and cost factors.

Computer Communication Networks↗
PubMed2001

Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care.

OBJECTIVE: To determine whether a decision aid on hormone replacement therapy influences decision making and health outcomes. DESIGN: Randomised controlled trial. SETTING: 26 general practices in the United Kingdom. PARTICIPANTS: 205 women considering hormone replacement therapy. INTERVENTION: Patients' decision aid consisting of an interactive multimedia programme with booklet and printed summary. OUTCOME MEASURES: Patients' and general practitioners' perceptions of who made the decision, decisional conflict, treatment choice, menopausal symptoms, costs, anxiety, and general health status. RESULTS: Both patients and general practitioners found the decision aid acceptable. At three months, mean scores for decisional conflict were significantly lower in the intervention group than in the control group (2.5 v 2.8; mean difference -0.3, 95% confidence interval -0.5 to -0.2); this difference was maintained during follow up. A higher proportion of general practitioners perceived that treatment decisions had been made "mainly or only" by the patient in the intervention group than in the control group (55% v 31%; 24%, 8% to 40%). At three months a lower proportion of women in the intervention group than in the control group were undecided about treatment (14% v 26%; -12%, -23% to -0.4%), and a higher proportion had decided against hormone replacement therapy (46% v 32%; 14%, 1% to 28%); these differences were no longer apparent by nine months. No differences were found between the groups for anxiety, use of health service resources, general health status, or utility. The higher costs of the intervention were largely due to the video disc technology used. CONCLUSIONS: An interactive multimedia decision aid in the NHS would be popular with patients, reduce decisional conflict, and let patients play a more active part in decision making without increasing anxiety. The use of web based technology would reduce the cost of the intervention.

Decision Making, Computer-Assisted↗
PubMedDate not supplied

The risks of multimedia methods: effects of actor's race and gender on preferences for health states.

OBJECTIVE: While the use of multimedia methods in medical education and decision support can facilitate learning, it also has certain hazards. One potential hazard is the inadvertent triggering of racial and gender bias by the appearance of actors or patients in presentations. The authors hypothesized that race and gender affect preferences. To explore this issue they studied the effects of actors' race and gender on preference ratings for health states that include symptoms of schizophrenia. DESIGN: A convenience sample of patients with schizophrenia, family members of patients, and health professionals was used. Participants were randomly assigned to rate two health states, one portrayed by either a man of mixed race (Hispanic-black) or a white man and the second portrayed by either a white woman or a white man. MEASUREMENTS: Visual analog scale (VAS) and standard gamble ratings of health state preferences for health states that include symptoms of mild and moderate schizophrenia. RESULTS: Studies of the effects of the race of the actor (n = 114) revealed that racial mismatch between the actor and the participant affected the participant's preferences for health states. Ratings were lower when racial groups differed (mean difference, 0.098 for visual analog scale ratings and 0.053 lower in standard gamble, P = 0.006 for interactions between the race of the subject and the actor). In studies of the effects of a female actress on ratings (n = 117), we found no evidence of a corresponding interaction between the gender of the actor and the study participant. Rather, an interaction between actor's gender and method of assessment was observed. Standard gamble ratings (difference between means, 0.151), but not visual analog scale ratings (difference, 0.005), were markedly higher when the state was portrayed by the actress (P = 0.003 for interactions between actor's gender and method of preference assessment). Differential effects on standard gamble ratings suggest that an actor's gender may influence the willingness of viewers to gamble to gain health benefits (or risk attitude). CONCLUSIONS: Educators and researchers considering the use of multimedia methods for decision support need to be aware of the potential for the race and gender of patients or actors to influence preferences for health states and thus, potentially, medical decisions.

Analysis of Variance↗
PubMed1996

Integrated multimedia timeline of medical images and data for thoracic oncology patients.

A prototype multimedia medical database has been developed to provide image and textual data for thoracic oncology patients undergoing treatment of advanced malignancies. The database integrates image data from the hospital picture archiving and communication system with textual reports from the radiology information system, alphanumeric data contained in the hospital information system, and other electronic medical data. The database presents information in a timeline format and also contains visualization programs that permit the user to view and annotate radiographic measurements in tabular or graphic form. The database provides an efficient and intuitive display of the changing status of oncology patients. The ability to integrate, manage, and access relevant multimedia information may substantially enhance communication among distributed multidisciplinary health care providers and may ensure greater consistency and completeness of patient-related data.

Databases, Factual↗
PubMedDate not supplied

Integration of a multimedia teaching and reference database in a PACS environment.

In one radiology department, a computerized authoring and editing environment was developed and integrated with the picture archiving and communication systems (PACS) for creation of image-based electronic teaching files to replace a collection of printed film images. This multimedia database and authoring environment allows physicians to create reference databases for teaching and research directly from clinical cases being reviewed on PACS diagnostic workstations. The database engine allows users to generate stand-alone CD-ROMs (compact disks, read-only memory) and World Wide Web-based teaching files. The system is fully compliant with the Digital Imaging and Communications in Medicine (DICOM) standard and supports a large number of standard multimedia image file formats. The focus of the development was on convenience and ease of use of a generic system adaptable to all users. The software was integrated on the PACS workstations to allow users to add new cases to the database at any time and anywhere in the department. A pilot system was implemented in clinical operation, with a central server and several client units.

CD-ROM↗
PubMed1998

It's a long way to multimedia: an account of 18 years of pursuing a new media project in physiology.

A teaching-oriented multimedia database authoring system, MILES ( Multimediales Informations- und Lehrsystem), has been in development since 1980 in our department. The hardware consists of a network of personal computers connected to digital and, until recently, audio/video storage devices. The system provides a database capable of handling all kinds of multimedia data and computer programs. User-friendly software provides input, editing, retrieval, and communication; the authoring system allows these components to be organized into structures of complex menus, combined with free database access. More than 12,000 components have been stored, including approximately 3,500 pictures. The paper reports on an extensive field test, in which the system has been applied as a common source for all kinds of materials used in teaching physiology to students of medicine. ResuIts show that the "new media" are powerful instruments for improving teaching and learning. However, they should not be expected to provide the sole basis for education. Their application still faces many problems regarding concepts, efficiency, and acceptance by students and staff.

Computer-Assisted Instruction↗
PubMed2002

Development and initial testing of a multimedia program for computer-assisted cognitive therapy.

A multimedia program for computer-assisted psychotherapy has been developed to help patients learn cognitive therapy skills. The program is designed to provide psychoeducation, teach self-help methods, and give information to clinicians on the patient's progress in using the software. Multimedia technology is utilized to engage users in the learning process and to make the program accessible for persons who do not have computer or keyboard skills. A preliminary study with 96 subjects who used the software along with treatment as usual found that 75 (78.1%) completed the entire program. Users indicated a high rate of acceptance of this form of computer-assisted therapy, and mean scores on a measure of cognitive therapy knowledge were significantly improved.

Adult↗
PubMed2006

A multimedia program helps parents manage childhood aggression.

Participants were 65 parents of 6- to 18-month-old children presenting for a well child checkup between September 2002 and February 2003 to one of two private pediatric offices. The intervention was a 30-minute multimedia program, Play Nicely, viewed at home, which teaches the basics in childhood aggression management. One year after intervention, parents were asked, "Do you feel that the CD program was helpful in managing aggressive behavior in your child?" Most (65%) parents who watched the program agreed that it helped them manage aggression with their own child (strongly agree, 31%; agree, 34%; uncertain, 28%; disagree, 7%; and strongly disagree, 0%). An inexpensive, brief, independently viewed, multimedia program helps parents manage aggression in their young children as long as 1 year after receiving it from their pediatrician. An easily implemented intervention may contribute to violence prevention efforts.

Adult↗