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PubMed1995

A multimedia guide to spinal cord injury: empowerment through self instruction.

The Spinal Cord Injury (SCI) Project is developing a series of instructional modules on SCI that will be distributed via CD-ROM for patient and family education. The modules are based on an instructional program and patient manual distributed by the Paralyzed Veterans of America. The program includes topics ranging from the anatomy and physiology of spinal cord injuries to legal rights established under the Americans With Disabilities Act. The SCI project expands on the instructional manual by combining digital multimedia techniques with motivational features such as games and personal guides. The user selects a personal guide from among a selection of individuals with spinal cord injuries to guide them through tutorials that include accounts of personal experiences. The guides appear in small video windows at various points throughout the tutorials and give personal insight into the topic at hand. The user can also query the other guides to hear their views on a topic. The user interface incorporates 'seamless access' features, which enable persons with a wide range of disabilities to use the program. Innovative features of these modules are the use of personal instructional guides, motivational games and activities, incorporation of alternative input or access strategies, and the use of high quality, low cost, multimedia production strategies.

Audiovisual Aids↗

PubMedDate not supplied

Telecommunications and multimedia systems in education: what developments for radiology?

What are the new perspectives for the radiologist with the development of new technologies of telecommunications? At present, when digitization of most biomedical images has become a reality, problems of remote transmission are simplified. However, telematic literacy is necessary to the radiologist. It is already possible through multimedia supports, as CD-ROM and Internet "navigation". Which are the modalities to access "the network of networks"? Through Internet, hypertexs can be consulted, databases can be accessed, programs and printings can be retrieved, electronic mail can be exchanged. The CD-ROM is a further source of knowledge, especially effective in education due to multimedia and hypertext technology. In this context in the education of the radiologist, the hypertext version of a radiology text, finds its place. It is conceived to offer to each user an individualized approach to learning.

Computer Communication Networks↗

PubMed1996

[The multimedia workstation, electronic assistant to the health care professional].

The health professional multimedia workstation is the natural entry point to health and knowledge networks. It should allow an easy and transparent management of all the data necessary for patient management. Multimedia nature of processed information reflects evolution of medical techniques that involve more and more complex objects such as video sequences or digitized signals. Workstations can be considered from 3 points of view: the professional end-users, the developers and the decision makers. The long term goal for the end-user is to establish an easy access in a working environment, that gives him/her the feeling of a single comprehensive application running on a single computer when the information system relies on a set of heterogeneous and geographically distributed components. Development of a workstation requires the integration into the same environment of tools to localize, access, manipulate and communicate the required information within a health information network. Analysis of the 445 Medline-indexed publications for the January 1991 to December 1994 period, that included the word workstation either in their title or in their abstract, helps in refining objectives and challenges both for the health professionals and the decision makers.

Computer Terminals↗

PubMed1996

[Computer-assisted multimedia interactive learning program "Primary Open-Angle Glaucoma"].

INTRODUCTION: Advances in the area of information technology have opened up new possibilities for the use of interactive media in the training of medical students. Classical instructional technologies, such as video, slides, audio cassettes and computer programs with a textbook orientation, have been merged into one multimedia computer system. The medical profession has been increasingly integrating computer-based applications which can be used, for example, for record keeping within a medical practice. The goal of this development is to provide access to all modes of information storage and retrieval as well as documentation and training systems within a specific context. MATERIAL AND METHODS: Since the beginning of the winter semester 1995, the Department of Ophthalmology in Giessen has used the learning program "Primary Open Angle Glaucoma" in student instruction. One factor that contributed to the implementation of this project was that actual training using patients within the clinic is difficult to conduct. Media-supported training that can provide a simulation of actual practice offers a suitable substitute. The learning program has been installed on Power PCs (Apple MacIntosh), which make up the technical foundation of our system. The program was developed using Hypercard software, which provides userfriendly graphical work environment. This controls the input and retrieval of data, direct editing of documents, immediate simulation, the creation of on-screen documents and the integration of slides that have been scanned in as well as QuickTime films. All of this can be accomplished without any special knowledge of programming language or operating systems on the part of the user. RESULTS: The glaucoma learning program is structured along the lines of anatomy, including an explanation of the circulation of the aqueous humor, pathology, clinical symptoms and findings, diagnosis and treatment. This structure along with the possibility for creating a list of personal files for the user with a collection of illustrations and text allows for quick access to learning content. The program is designed in such a way that working with and through it is done in a manner conducive to learning. Student response to the learning program as an accompaniment to instruction has been positive. CONCLUSION: Independent, supplemental student learning by means of an interactive learning program has raised the quality of study within the sciences. The use of a pedagogically sound multimedia program, that is oriented toward problem solving and based on actual cases offers students the opportunity to actively work ophthalmological material. An additional benefit is the development of competence in working with computer-support information systems, something that is playing an ever-increasing role within the medical profession.

Computer-Assisted Instruction↗

PubMed2000

Attacking anxiety: a naturalistic study of a multimedia self-help program.

The effects of a commercial multimedia self-help program (Attacking Anxiety) were evaluated by examining the outcome of 176 individuals who participated in the treatment. Results suggested that 62 individuals suffering from anxiety achieved clinically significant improvement. An additional 40 achieved reliable change, despite the fact that these individuals had suffered from anxiety-based problems for years prior to their participation. Only one participant experienced negative change. These results are discussed in relation to the growing literature on self-help interventions and the limitations imposed by the naturalistic nature of the investigation.

Adult↗

PubMed1996

Toward virtual anatomy: a stereoscopic 3-D interactive multimedia computer program for cranial osteology.

Advances in computer visualization and user interface technologies have enabled development of "virtual reality" programs that allow users to perceive and to interact with objects in artificial three-dimensional environments. Such technologies were used to create an image database and program for studying the human skull, a specimen that has become increasingly expensive and scarce. Stereoscopic image pairs of a museum-quality skull were digitized from multiple views. For each view, the stereo pairs were interlaced into a single, field-sequential stereoscopic picture using an image processing program. The resulting interlaced image files are organized in an interactive multimedia program. At run-time, gray-scale 3-D images are displayed on a large-screen computer monitor and observed through liquid-crystal shutter goggles. Users can then control the program and change views with a mouse and cursor to point-and-click on screen-level control words ("buttons"). For each view of the skull, an ID control button can be used to overlay pointers and captions for important structures. Pointing and clicking on "hidden buttons" overlying certain structures triggers digitized audio spoken word descriptions or mini lectures.

Adult↗

PubMed2004

Randomised trial comparing an interactive multimedia decision aid with a leaflet and a video to give information about prenatal screening for Down syndrome.

OBJECTIVES: (1)To compare an interactive multimedia decision aid (IMDA) with a leaflet and a video to give information about prenatal screening for Down syndrome and (2) to determine the women's acceptance of IMDA. METHODS: Two hundred and one women were recruited from the prenatal clinic of a university teaching hospital and randomised into the intervention group (IMDA, video, and information leaflet) or the control group (video and information leaflet). RESULTS: There were no significant differences in the initial decision for and the final uptake of the prenatal screening test between the control and intervention groups. The proportion of women who were undecided was less than 10% in both groups. Of the women in the intervention group, 86.6% and 78.9% agreed that IMDA was user-friendly and acceptable, respectively. Significantly more women aged < 35 (88.1%) accepted IMDA than women aged > or = 35 (68.3%) (P = 0.030), but the logistic regression analysis did not confirm this finding after adjusting for other factors (computer knowledge and usage of computer). CONCLUSION: The use of IMDA did not affect the women's overall uptake rate of the prenatal screening test for Down syndrome. More women less than 35 years accepted IMDA probably because they used computer more frequently and had more computer knowledge.

Adult↗

PubMed2002

["Multimedia symposium wares". An enrichment of medical and graduate education?].

The continual development of the internet has supported the spread of surgical knowledge by electronic means. High quality products have to be offered from a software as well as a contents point of view. The question as to whether these new media and their contents have a real value for efficient and motivating use in medical education needed to be answered by first assessing a quality profile for the development of surgical educational modules which were then evaluated on the basis of so-called "symposia ware". First, the reactions and opinions of physicians at 47 universities were assessed by a standardized questionnaire concerning their demands on multimedia teaching/learning modules. Several different aspects of technique, content, presentation, didactics and background knowledge were analyzed. In a second step, their opinions were evaluated concerning two applications (symposia implemented on CD-ROM as a slideshow with original slides and audio) with surgical and gastroenterological contents by standardized questionnaire. Questions concerning personal background such as educational status and experience with computers, e-mail and the internet on one hand and the CD-ROM itself concerning content, relevance for daily clinical work and continuing medical education as well as the quality of the application on the other hand, were evaluated using marks (1 = best, 6 = worst). A total of 320 physicians participated in the first part of the interview. Of these, 93% were equipped with computers in hospital as well as privately. The Internet was used by 90% of them. The majority declined a full text presentation as well as the application of scroll fields. The participants rather favored the integration of text, pictures, animations and videos. Furthermore, 95% demanded the provision on the internet. Thirty-seven colleagues in their 5th (1-11) year of training were interviewed, and of those, 27 were working in a surgical department and 10 in a medical department. Individual computer knowledge was rated with a median of 3. This revealed that 60% were equipped with computers in hospital as well as at home, the remaining 40% had computers either in hospital or at home. All participants used the internet. In total, 57% had experience with "Symposia ware". The rating of the "Symposia ware" itself was positive. Relevance and applicability of a slideshow for imparting knowledge were rated with a median of 2. This showed that 81% would buy the CD-ROM in principle, and 89% would spent up to 50 EUR. Quality, language, content and user-friendliness were all rated 2. Physicians frequently use computers and the internet. All this indicates a high degree of acceptance of electronic teaching/learning modules in medical education. A uniform structure of contents as well as a platform-independent, web-based presentation is appreciated. To enhance illustration, a picture and video-oriented visualization should be chosen. Overall, "symposia ware" is rated positively. It should cost no more than 50 EUR and it represents a valuable source of information for physicians.

CD-ROM↗

PubMed2000

Learning about the dynamic swallowing process using an interactive multimedia program.

The management of dysphagia is the largest recognized subspecialty in the field of speech-language pathology. Practicing speech-language pathologists require a comprehensive theoretical and functional knowledge base to underpin the safe and effective management of people with dysphagia. Students need to develop an understanding of the normal integrated swallow and how it can be affected to appreciate the assessment or treatment of dysphagia. Although students are well motivated to learn this material, assimilating knowledge of the dynamic nature of the swallow has typically been problematic because of its complex character. The limitations of currently available teaching resources have been addressed by the production of an interactive multimedia program that includes integrated presentation of text, graphics, voice-overs, and video and animation sequences to highlight various aspects of the swallowing process. Students can selectively manipulate parts of this process to understand the normal swallow and to simulate different aspects of dysfunction and the consequent effects on swallow safety and efficiency. Feedback from students, faculty, and experts has demonstrated that The Dynamic Swallow would be a valued tool in the teaching of dysphagia.

CD-ROM↗

PubMed2004

Web-based delivery of medical multimedia contents using an MPEG-4 system.

Moving picture expert group compression standard version 4 (MPEG-4) is a standard for video coding aimed at multimedia applications. MPEG-4 was developed to enable high compression rate in a low bitrate transmission via the Internet or mobile telecommunications. Although these characteristics of MPEG-4 are suitable for telemedicine, little is known about the possibility of using this technology in the field of telemedicine. We evaluated the quality of MPEG-4-encoded medical video streams and compared them with original analogue videos and audio-video-interleave (AVI) files. Although MPEG-4 video streams have the advantage of small file size, they were found to be inferior to original videos and AVI files in terms of smoothness of motion pictures, sharpness of images and clearness of sound. Illegibility of characters was a major problem in MPEG-4 files. The score for total impression of MPEG-4 files was significantly lower than those for AVI files. The results of this study suggest that the quality of MPEG-4-encoded video streams is not adequate for telemedicine.

Humans↗

PubMed2005

Public health benefits of compliance with current E.U. emissions standards for municipal waste incinerators: a health risk assessment with the CalTox multimedia exposure model.

The Angers municipal solid waste incineration plant, in operation since 1974, was upgraded in 2000 to comply with new European standards. This article discusses the risks associated with past and present emissions from the incinerator and its nearby furnace. Emissions of SO(2), HCl, particulate matter, lead, mercury, cadmium and dioxins were studied. We characterised the risks associated with exposure via inhalation and ingestion of locally grown products, before and after the upgrade. Emissions were estimated from regulatory measurements, and ambient air concentrations estimated with a Gaussian dispersion model. The CalTox multimedia model was used to calculate concentrations in the food chain. Food intake rates came from a nationwide survey. Inhalation exposure to respiratory irritants produced a hazard ratio less than 1 in all scenarios, except for SO(2) in the immediate neighbourhood of the incinerator, before the change in furnace fuel and in case of high-pressure weather conditions. The individual excess risk of cancer was less than 10(-6) and the hazard ratios for metals were less than 1. Before compliance, the average dioxin exposure attributable to the incinerator accounted for roughly one quarter of the average total exposure from traffic and other combustion activities. Although the corresponding hazard ratio was less than 1, the individual lifetime excess risk, assuming no change in emissions, was 2 x 10(-4). After compliance, all hazard ratios and future individual lifetime excess risks appear minimal. These results are consistent with environmental data and other studies, but many uncertainties remain, such as intermedia transfer coefficients for dioxins. Nevertheless compliance has vastly reduced the probability of health effects.

Air Pollutants↗

PubMed2005

Comparative validation of a bilingual interactive multimedia dietary assessment tool.

OBJECTIVE: To perform comparative validity testing for a bilingual interactive multimedia (IMM) dietary assessment tool that mimics a dietary recall against an interview-administered dietary recall. DESIGN: This was a two-period crossover design study. First, participants were randomly assigned to complete an IMM recall or interview-administered 24-hour recall. The IMM recall generated a nutrient profile that included 20 dietary constituents. The interview-administered recall was analyzed using the Food Intake Analysis System (FIAS) and the Expanded Food and Nutrition Education Program (EFNEP) Evaluating/Reporting System. The effect of substituting standardized portion sizes for reported portion sizes was examined. SUBJECTS/SETTING: Of 80 adult participants, 71 (91%) were female, 45 (56%) had 12th grade or less education, 65 (81%) had an annual income of dollar 15,000 or less, and 21 (26%) completed the IMM recall in Spanish. STATISTICAL ANALYSES PERFORMED: Analysis of variance and unadjusted and energy-adjusted correlations were used. RESULTS: No significant group differences were found for order of administration or demographic characteristics. There was only one significant (P=.025) method effect, whereby vitamin C intake was higher in the IMM recall than the FIAS. The unadjusted correlations between the IMM recalls and interview-administered recalls analyzed using both FIAS and EFNEP Evaluating/Reporting System were generally approximately 0.6. Energy-adjusted correlations were consistently lower. Substituting standardized portion sizes resulted in significant differences for six nutrients and caused all correlations to decrease. CONCLUSIONS: The IMM dietary recall is a valid method for assessing dietary intake within the tested group. The results of comparative validity testing and positive reactions received from participants and nutrition educators indicate that diet assessment using IMM has tremendous potential.

Adolescent↗

PubMed2005

The multimedia computer for office-based patient education: a systematic review.

Use of the multimedia computer for education is widespread in schools and businesses, and yet computer-assisted patient education is rare. In order to explore the potential use of computer-assisted patient education in the office setting, we performed a systematic review of randomized controlled trials (search date April 2004 using MEDLINE and Cochrane databases). Of the 26 trials identified, outcome measures included clinical indicators (12/26, 46.1%), knowledge retention (12/26, 46.1%), health attitudes (15/26, 57.7%), level of shared decision-making (5/26, 19.2%), health services utilization (4/26, 17.6%), and costs (5/26, 19.2%), respectively. Four trials targeted patients with breast cancer, but the clinical issues were otherwise diverse. Reporting of the testing of randomization (76.9%) and appropriate analysis of main effect variables (70.6%) were more common than reporting of a reliable randomization process (35.3%), blinding of outcomes assessment (17.6%), or sample size definition (29.4%). We concluded that the potential for improving the efficiency of the office through computer-assisted patient education has been demonstrated, but better proof of the impact on clinical outcomes is warranted before this strategy is accepted in the office setting.

Attitude to Computers↗

PubMed2006

Effects of a tailored interactive multimedia computer program on determinants of colorectal cancer screening: a randomized controlled pilot study in physician offices.

OBJECTIVE: Screening reduces colorectal cancer (CRC) mortality and is cost-effective, yet uptake is suboptimal. We developed and evaluated a personally tailored interactive multimedia computer program (IMCP) to encourage CRC screening. METHODS: Randomized controlled pilot trial evaluating the effects of the personally tailored CRC screening IMCP as compared with a non-tailored IMCP ("electronic leaflet") control. The IMCP was tailored to patient preference, self-efficacy, barriers, and readiness and deployed in busy primary care offices before scheduled doctor visits. Main outcomes were: CRC screening knowledge, self-efficacy, benefits and barriers, and stage of readiness. RESULTS: We enrolled 54 subjects; software glitches occurred in 5, leaving 49 subjects for analysis. In adjusted analyses, compared with control, the experimental group had a significant increase in CRC screening self-efficacy (p=0.049), a significantly greater likelihood of moving to a more advanced stage of readiness for screening (p=0.034), a trend toward fewer perceived barriers to screening (p=0.149), and no difference in perceived benefits or knowledge of screening. CONCLUSION: Our personally tailored IMCP was significantly more effective than control in bolstering CRC screening readiness and self-efficacy. PRACTICE IMPLICATIONS: If further streamlined, personally tailored IMCPs might be usefully deployed in busy primary care offices to improve uptake of CRC screening.

Algorithms↗

PubMed2000

Effectiveness of a CD-ROM multimedia tutorial in transferring cognitive knowledge essential for laparoscopic skill training.

BACKGROUND: Computer-assisted instruction (CAI) can benefit surgical education by improving efficiency, effectiveness, standardization, and access. This study compares knowledge gains for laparoscopic skill acquisition following a standardized tutorial delivered via CD-ROM versus live instructor. METHODS: A standardized tutorial was written and subsequently converted to multimedia CD-ROM format by its author (JR). During a laparoscopic development course, experienced US-trained surgeons (n = 52) participated in the tutorial delivered live by the author. The CD-ROM tutorial replaced the instructor for the following groups: (1) experienced US-trained surgeons (n = 27); (2) US-trained surgical residents (n = 59); and (3) Greek surgeons (n = 63). A 51-item knowledge test was administered before and after tutorial instruction. RESULTS: The mean increase in scores between pretest and posttest was significant (P <0.01) and of similar magnitude in each group, with nonsignificant posttest mean differences among US-trained groups. CONCLUSIONS: The CD-ROM tutorial effectively transfers cognitive information necessary for skill development. Distance learning modes of this tutorial program may be feasible.

CD-ROM↗

PubMed1998

Organizational considerations for an electronic curriculum. Part II: A multimedia approach to dental education in general and to prosthodontics in particular.

STATEMENT OF PROBLEM: In using multimedia electronic knowledge-transfer as a tool in dental education, an overriding concern has centered on how to devise an organizational model that will accommodate the vast and diverse arrays of information involved, yet be sufficiently simple to provide students with a rational and consistent means of accessing the information they require. PURPOSE: This article presents a model that adopts the Natural History of Dental Diseases as the organizing principle. This article also encourages a mindset in prosthodontics that focuses on the dynamics of energy-dispersal through the supporting structures, in an attempt to provide learners with a deeper cognitive dimension for problem solving and to facilitate their empowerment as life-long learners.

Computer-Assisted Instruction↗

PubMed2001

Strategies for including vegetation compartments in multimedia models.

The incentives for including vegetation compartments in multimedia Level I, II and III fugacity calculations are discussed and equations and parameters for undertaking the calculations suggested. Model outputs with and without vegetation compartments are compared for 12 non-ionic organic chemicals with a wide variety of physical-chemical properties. Inclusion of vegetation compartments is shown to have a significant effect on two classes of chemicals: (1) those that are taken up by atmospheric deposition and (2) those that are taken up by transpiration through the plant roots. It is suggested that uptake from the atmosphere is important for chemicals with logK(OA) greater than 6 and a logK(AW) of greater than -6. Plant uptake by transpiration is important for chemicals with logK(OW) less than 2.5 and a logK(AW) of less than -1. At logK(OA) > 9 atmospheric uptake is dominated by particle-bound deposition and the importance of partitioning to vegetation is largely dependent on the relative magnitude of the particle deposition velocities to soil and vegetation. These property ranges can be used to determine if a chemical will significantly partition to vegetation. If the chemical falls outside the property ranges of the two classes it will probably be unnecessary to include vegetation in models for assessing environmental fate. The amount of chemical predicted to partition to vegetation compartments in the model is shown to be highly sensitive to certain model assumptions. Further experimental research is recommended to obtain more reliable equations describing equilibrium partitioning and uptake/depuration kinetics.

Air Pollutants↗

PubMed2002

A regionally segmented national scale multimedia contaminant fate model for Canada with GIS data input and display.

Regional scale mass balance models are valuable tools for describing the fate of chemicals in areas with defined and fairly homogeneous environmental characteristics and chemical use patterns. These models often show that contaminant inflows from outside the region of interest are significant compared with local emissions. This is most likely for persistent chemicals and those that are efficiently transported in air or water. As a result regional levels of environmental contamination are controlled by external factors and meaningful evaluation requires assessment of contaminant fate in neighboring regions. A linked set of regional models thus has the potential to describe quantitatively the impact of chemical emissions over a wider geographic scale with significant spatial differences in environmental characteristics and chemical use patterns. We describe here a national scale contaiminant fate model for Canada based on the existing 24-region ChemCAN model. The ecological regions, which were previously treated individually, are linked with flows of air and water deduced from GIS analysis to provide a comprehensive description of contaminant fate over the entire country, including long-range transport between regions. The model is applied to describe the national-scale fate of three chemicals in Canada, benzene, trichloroethene, and diethylhexyl phthalate, exploiting GIS analysis for interpretation and presentation of model results. Agreement between predicted multimedia environmental concentrations and measured values is satisfactory for all three chemicals. In total this work represents an initial attempt to address the different processes of both linking a regional model and using GIS as a tool for data analysis and management.

Air Movements↗