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PubMed2000

Web-based continuing medical education. (II): Evaluation study of computer-mediated continuing medical education.

BACKGROUND: Over the years, various distance learning technologies and methods have been applied to the continuing medical education needs of rural and remote physicians. They have included audio teleconferencing, slow scan imaging, correspondence study, and compressed videoconferencing. The recent emergence and growth of Internet, World Wide Web (Web), and compact disk read-only-memory (CD-ROM) technologies have introduced new opportunities for providing continuing education to the rural medical practitioner. This evaluation study assessed the instructional effectiveness of a hybrid computer-mediated courseware delivery system on dermatologic office procedures. METHODS: A hybrid delivery system merges Web documents, multimedia, computer-mediated communications, and CD-ROMs to enable self-paced instruction and collaborative learning. Using a modified pretest to post-test control group study design, several evaluative criteria (participant reaction, learning achievement, self-reported performance change, and instructional transactions) were assessed by various qualitative and quantitative data collection methods. RESULTS: This evaluation revealed that a hybrid computer-mediated courseware system was an effective means for increasing knowledge (p < .05) and improving self-reported competency (p < .05) in dermatologic office procedures, and that participants were very satisfied with the self-paced instruction and use of asynchronous computer conferencing for collaborative information sharing among colleagues.

Adult↗
PubMed1994

High-resolution anatomy from in situ human brain.

We have generated a spatially accurate, high-resolution three-dimensional (3D) volume of brain anatomy from cryosectioned whole human head. The head of a female cadaver was cryosectioned on a heavy duty cryomacrotome (PMV, Stockholm Sweden) modified for quantitative digital image capture. Serial images (1024(2), 24-bit) were captured directly from the cryoplaned specimen blockface in 500-micron intervals and reconstructed to a 3D data volume. Data were placed into the Talairach coordinate system to create a volume of brain anatomy for atlas reference. We resampled the volume at 500 microns along the sagittal, coronal, and horizontal planes and enhanced the images by digitally editing the background. The spatial resolution of the original digitized images provided sufficient anatomic detail to clearly delineate gray and white matter and neural structures, including major fiber pathways, subthalamic nuclei, and laminae. We developed a compact disk and controlling software program to enable the viewer to select planes of orientation, display, and copy individual to sections at higher resolution. Animation proved useful in the conveyance of system anatomy as structures are shown traversing through the neuroaxis. Postmortem cryosectioning paired with this computerized presentation allowed the complete 3D volume data to be distributed and shared as an educational, clinical, and research resource.

Aged↗
PubMed1997

Teleradiology in urology: comparison of digital image quality with original radiographic films to detect urinary calculi.

PURPOSE: Teleradiology systems are now being evaluated as a mechanism to provide rapid, accurate and cost-effective diagnostic radiographs to off-site physicians. Little data are available on the role and safety of teleradiology in urology. To address these issues a personal computer based system was developed to assess the diagnostic accuracy and ease of use of transmitted digital images when evaluating for urinary calculi. MATERIALS AND METHODS: A total of 100 plain abdominal scout films from excretory urograms performed during acute urological referrals was digitized on a laser scanner. The 10 megabyte files were transferred over public telephone lines and written to compact disks. The images were viewed on a 1280 x 1640 resolution monitor using "Imager-3D" software run on a 133 MHz. pentium personal computer with 32 megabytes of random access memory. Two faculty urologists and 2 urology fellows each looked at 50 original radiographs and 50 digital images. Diagnostic interpretations of the presence and location of calculi were recorded, and confidence in the diagnosis, assessment of image quality and diagnostic difficulty were scored using a numerical scale. RESULTS: The accuracy for all readers was 86.5% for plain radiographs and 81.5% for digital images (p >0.2). There was no statistical difference between faculty and fellows. Diagnostic accuracy did not differ between plain films and screen images when the results were assessed with respect to image quality, diagnostic difficulty or the reader confidence in the diagnosis (p >0.1). Compared to plain films, more screen images were classified as lower image quality (60 versus 40%) and the diagnostic confidence was lower (low and medium grade 50 versus 35%), although this did not interfere with diagnostic accuracy. CONCLUSIONS: These data imply that a high quality affordable teleradiology system is effective and accurate compared to plain films for assessing urinary calculi.

Humans↗
PubMed1992

A comparison of the currency of secondary information sources in the biochemical literature. II. MEDLINE online and on CD-ROM.

The currency of selected versions of the MEDLINE database on CD-ROM and in online format was studied. The arrival of issues from 72 monthly journals and nine weekly titles during a 3-month period was monitored and their appearance in the various MEDLINE formats were recorded. Availability data for MEDLINE published by the National Library of Medicine were used as a baseline and subsequent distribution delays for the different MEDLINE formats were calculated. The study suggests a delay of approximately 2 weeks for indexing and mounting the MEDLINE file on to host computers for online access. A delay of 6-8 weeks was calculated for the MEDLINE data to be encoded on to compact disk, shipped and posted to the library customer. The currency of the MEDLINE database formats was compared with a weekly current-awareness service, CURRENT CONTENTS ON DISKETTE LIFE SCIENCES (CCOD). The majority of papers were indexed and distributed in CCOD within 10 weeks of publication date. Most papers appeared within 15 weeks in the online MEDLINE format and within 20 weeks in CD-ROM MEDLINE. The primary journal arrived at the library site within 5 weeks in most cases.

CD-ROM↗
PubMed1997

[Speech audiometry with logatomes].

BACKGROUND: Logatomes are nonsense syllables used for analyzing the confusion of phonemes by hearing impaired listeners. They can provide a precise differentiation of phonemic confusions which may be useful in the exact adjustment of programmable hearing aids. METHODS: In this study, two lists of logatomes with 108 three-sound combinations with a structure of consonant-vowel-consonant (c-v-c) and vowel-consonant-vowel (v-c-v) were recorded on a compact disk. Twenty normally hearing adults and 28 patients with a sensorineural hearing loss were tested at a comfortable listening level of about 25 +/- 5 dB above the mean audiometric thresholds at 0,5. 1,0 and 2,0 kHz. An index of reduction of speech perception was calculated. RESULTS: A significant relationship between reduction of logatome perception and pure-tone audiometric thresholds at 1,2,3, and 4 kHz was demonstrated. Moreover, it was possible to distinguish between different groups of hearing impairment. CONCLUSIONS: The logatome test helps to analyze specific effects that hearing loss can have on the recognition of acoustic speech signals. The logatome test may become a valuable addition to speech audiometric tests with further standardization.

Adult↗
PubMed2000

A brief history of the Journal of Bone and Joint Surgery.

The Journal of Bone and Joint Surgery had its origins in the Transactions of the American Orthopedic Association, which first were published in 1889. In 1903, the Transactions of the American Orthopedic Association, Volume 16, became the first volume of the American Journal of Orthopedic Surgery, still under the sponsorship of the American Orthopedic Association. In 1919, the word American was dropped from the title and the Journal of Orthopaedic Surgery became the official publication of the newly formed British Orthopaedic Association and the American Orthopedic Association. The name was changed to The Journal of Bone and Joint Surgery in 1921. Shortly after the founding of the American Academy of Orthopaedic Surgeons in 1933, The Journal became the official organ of the academy; however, ownership of The Journal remained with the American Orthopaedic Association. The British volume appeared in 1948. The Journal of Bone and Joint Surgery became an independent, not-for-profit corporation in 1954. The Journal, which continues to be a leader in the area of orthopaedic publication, began publishing the full text on compact disk in January 1992, the full text in electronic form through BRS/Saunders in 1995, and the full text on The Journal's website in December 1999.

History, 19th Century↗
PubMed1993

New perspectives in radioimmunoassay.

In addition to providing the basis of 'ultrasensitive' immunoassays, nonisotopic labels permit development of 'user friendly' methodologies, including simple devices designed for extralaboratory use and intended to provide yes/no answers to basic diagnostic questions, for example, the presence of an infectious disease, the commencement of pregnancy etc. Immunosensors are also intended to fulfil these objectives (albeit yielding quantitative information), but despite much research the prospect of adequately sensitive instruments of this type remains remote. Finally, nonisotopic labels enable the development of a new generation of miniaturized multianalyte assays permitting in principle the determination of entire analyte menus in small samples of body fluids. Such technologies will resemble those employed in compact disk recorders and other data-storage devices, differing only in that light emitted from discrete zones on a solid surface is fluorescent (or possibly chemiluminescent) rather than reflected, and yields chemical rather than physical information. The emergence of such technologies, will, inter alia, facilitate the screening of entire populations for infectious disease, endocrine dysfunctions, genetic abnormalities etc. using, for example, finger-tip blood samples, throat and endocervical swabs, and hopefully will contribute to the large-scale diagnosis and ultimate reduction of disease.

Humans↗
PubMed1998

Bladder injury during laparoscopic surgery.

The objective of this review is to present the incidence of latrogenic bladder injury associated with diagnostic and/or operative laparoscopic surgery; to determine the type of primary laparoscopic operation, the time at which the reported injuries occurred, the location of injuries, and the method(s) used to repair those injuries; to decide which laparoscopic procedure carries the highest risk for bladder injury; and to establish the most frequent surgical instruments with which injuries happened. World literature published between 1970 and 1996 was reviewed. The appropriate Medical Subject Heading (MeSH) terms were selected and used in a search of the MEDLINE, ACOGNET, OVID Compact Disk Version database. A total of 1372 articles on laparoscopic surgery complications were reviewed. Of that number, a total of 77 articles identified bladder injuries, and these were analyzed for the objectives of this study. There are a wide range of bladder injuries during laparoscopic procedures. In the studied articles, the incidence of bladder injury during laparoscopic procedures ranged from 0.02 to 8.3 percent of cases. Most frequently, these injuries occurred during laparoscopic-assisted vaginal hysterectomy. Sharp electrosurgical dissection was the leading instrument causing injury. An intraoperative diagnosis of bladder injury was made in 53.24 percent of all bladder injury cases. The bladder dome was the most commonly injured structure. Less than half (29.87 percent) of the bladder injuries were corrected laparoscopically.

Female↗
PubMed1994

Computerized scientific exhibit in radiology: a valuable format for delivering scientific information.

The computerized scientific exhibit (CSE) is gaining acceptance as a tool for delivering scientific information at meetings of radiologic societies. CSEs allow presentation of more material in a more space-efficient manner than do conventional exhibits, and the viewer can control the order and detail in which material is reviewed. As a disadvantage, currently, the radiologist must use a support team and learn new tools to create a CSE. The preparation and cost may also be greater. Meeting attendees must overcome a reluctance to use computers to benefit from a CSE. Creation of a CSE has design, production, and presentation phases. A team of content authors, software author, graphics acquisition person, and project manager works together through brainstorming, conceptual ordering, storyboarding, prototyping, and selection of authoring tools to design the exhibit. Production must include use of common word processing and image file formats, as well as standardization of image resolution. Accurate equipment specification is needed to ensure that the exhibit can be run on the equipment provided by the meeting organizers. In addition, some security steps are needed to prevent misuse of the exhibit. In addition to display at assemblies, the CSE can be made available to a larger audience by delivery on media such as compact disks and the Internet and can be continually modified as new material becomes available.

Computers↗
PubMed1995

A low-cost CD-ROM--based image archival system.

Many radiologists have large collections of original or copied radiographs, as well as 35-mm slides of radiographs that require conventional carousel-type projectors for display. These images cannot be digitally manipulated or displayed in other formats. The authors used compact disk, read-only memory (CD-ROM) technology as a low-cost method of digitally storing these images. The CD-ROM disks were created from slide images optically scanned and digitally transferred to a disk. The images may be incorporated into any type of computer application, used on multiple computer platforms, and are easily transportable. The process is a low-cost, high-quality method of transferring images to digital media and is currently available to anyone with a conventional 35-mm camera, a CD-ROM reader, and a computer.

CD-ROM↗
PubMedDate not supplied

Computer-aided design and modeling of workstations and radiology reading rooms for the new millennium.

Three-dimensional (3D) computer modeling, simulation, and rendering techniques were used to redesign the diagnostic workstations and radiology reading rooms for a proposed hospital with particular attention given to lighting conditions, noise reduction, and optimal use of limited workspace. The results were presented to a panel of multidisciplinary experts and iteratively improved and redesigned with the development or addition of new design criteria or requirements. These 3D techniques allowed faster, more efficient design and presentation of multiple options than is possible with traditional two-dimensional drawings, thereby expediting decision making and resulting in significant savings. The current workstation designs can easily be developed and implemented with available technology at a reasonable cost. They can also accommodate anticipated advances in computer and display technology as well as new imaging paradigms (eg, changes in keyboard and control ergonomics such as adjustable virtual keys on touch-sensitive screens, digital drawing tablets for annotations and controls, direct film digitizing, personal identification devices, offline media readers such as compact disks and digital videodisks, and speech recognition and voice activation). Use of 3D techniques in designing other parts of the radiology department (eg, examination rooms, technologists' areas, physicians' offices) could greatly improve and facilitate the design and implementation of complex settings in these work areas.

Computer Simulation↗
PubMed1989

Hypermedia techniques for diagnostic imaging instruction: videodisk echocardiography encyclopedia.

Because of the visual complexity of medical images and the intensive tutorial experience required to develop image recognition expertise, professional training programs have concentrated on educating limited numbers of experts. Videodisk and CD-ROM (compact disk read only memory) image storage media now make it possible for a microcomputer workstation to provide a learning environment substantially equivalent to that of conventional time-consuming tutorial methods. A demonstration hypermedia program on echocardiography was constructed that provides a user-controlled learning environment with instant access to 54,000 video frames encompassing 1,200 clinical items. The instructional module is controlled by a microcomputer, which provides electronic linkage to relevant graphics, animations, text, categorized data bases, and digitized sound. The system has been successfully used in a residency program as the primary instructional tool for achieving an intermediate level of clinical expertise. Hypermedia offer substantial advantages over conventional books as a clinical reference source.

Computer-Assisted Instruction↗
PubMed1991

Comparison and evaluation of nine bibliographic databases concerning adverse drug reactions.

Few evaluations and statistical comparisons of bibliographic databases have been published. As a drug information center, we were particularly interested in databases providing references on adverse drug reactions (ADRs). Ten drugs were randomly chosen from the 2000 files at our center. Nine databases were selected according to the high frequency of references concerning ADRs: eight online systems (MEDLINE, BIOSIS, TOXLINE, Iowa Drug Information System, PASCAL, EMBASE, PHARMLINE, and International Pharmaceutical Abstracts [IPA]), and one Compact Disk Read Only Memory (CD-ROM) system (Core MEDLINE). The total number of references, the number of references from 1987 to 1989, and the number of relevant references from 1987 to 1989 were analyzed using the Friedman two-way ANOVA by ranks. The overlap between databases for only one drug, carboplatin, and the quality:cost ratio were also studied. Considering the total number of references, TOXLINE and EMBASE were significantly superior to IPA, PHARMLINE, PASCAL, and Core MEDLINE. For the period 1987-1989, EMBASE was significantly superior to PASCAL, IPA, PHARMLINE, and Core MEDLINE with regard to total number of references, and significantly superior to PASCAL, Core MEDLINE, and IPA with regard to relevance. MEDLINE, TOXLINE, and EMBASE had the best quality:cost ratio. EMBASE had the slightest overlap of references, with 53 percent of the unique references on carboplatin. This comparative evaluation showed that the ability of bibliographic databases to provide information on ADRs is dependent on both the size and the quality of each database.

Databases, Bibliographic↗
PubMedDate not supplied

Research-oriented image registry for multimodal image integration.

To provide multimodal biomedical images automatically, we constructed the research-oriented image registry, Data Delivery System (DDS). DDS was constructed on the campus local area network. Machines which generate images (imagers: DSA, ultrasound, PET, MRI, SPECT and CT) were connected to the campus LAN. Once a patient is registered, all his images are automatically picked up by DDS as they are generated, transferred through the gateway server to the intermediate server, and copied into the directory of the user who registered the patient. DDS informs the user through e-mail that new data have been generated and transferred. Data format is automatically converted into one which is chosen by the user. Data inactive for a certain period in the intermediate server are automatically achieved into the final and permanent data server based on compact disk. As a soft link is automatically generated through this step, a user has access to all (old or new) image data of the patient of his interest. As DDS runs with minimal maintenance, cost and time for data transfer are significantly saved. By making the complex process of data transfer and conversion invisible, DDS has made it easy for naive-to-computer researchers to concentrate on their biomedical interest.

Computer Communication Networks↗
PubMedDate not supplied

A debunking of the myth of healthy Asian Americans and Pacific Islanders.

PURPOSE: To present evidence that the model of healthy Asian Americans and Pacific Islanders (AAPIs) stereotype is a myth. SEARCH METHOD: The authors retrieved literature from the National Library of Medicine's compact disk databases (Cancerlit, CINAHL, Health, and MEDLINE), and examined pertinent federal government publications supplemented by the authors' knowledge of other published materials. IMPORTANT FINDINGS: This review paper presents three reasons why AAPIs are underserved: (1) the population growth rate has been unusually rapid and recent; (2) data regarding the health status of AAPIs are inadequate; and (3) the myth that AAPIs are model minority populations in terms of their health status was promulgated. MAJOR CONCLUSIONS: The conclusions are as follows: (1) AAPIs are heterogenous with respect to demographic factors and health risk factors; (2) because the current databases on the health status of AAPIs include small sample sizes, both the quantity and quality of these data need to be improved with respect to appropriate gender and ethnic group representation; (3) Risk factor and mortality data for AAPIs suggest that the burden of certain preventable diseases, namely, tuberculosis, hepatitis-B, liver cancer, and lung cancer may be higher than those of any other racial and ethnic population. The model healthy AAPI stereotype is a myth.

Asia↗
PubMed1992

Instructing occupational therapy students in information retrieval.

The effectiveness of a brief program designed to teach occupational therapy students enrolled in a graduate research methods class to conduct searches of four electronic databases was investigated. Students in the experimental class read an instructional booklet and received approximately 1 hour of supervised practice time using compact disk--read-only memory (CD-ROM) equipment. Questionnaire data revealed that compared with the students in the control class, the students completing the training program reported being significantly more familiar with six of seven key concepts and indicated significantly higher levels of usage of the four databases studied in the program.

CD-ROM↗
PubMed1999

Environmental air sampling to detect biological warfare agents.

The rapid and unequivocal detection and identification of biological warfare agents is a major goal of military and civilian defense authorities. To identify agents of concern in an environmental sample, a reliable, region-specific characterization of the microorganisms found naturally at the sampling location is required. We have analyzed environmental air samples from Korea, Kuwait, and Bahrain by polymerase chain reaction and temporal temperature gradient electrophoresis and have produced genetic fingerprints of the natural microbial flora in these regions. Results are displayed as specific bar code patterns against which the unique patterns of potential biological warfare agents appearing in a sample can be quickly discriminated. Data are stored on compact disk, along with other laboratory analyses and relevant meteorological data, and are available to appropriate authorities and researchers.

Air Microbiology↗
PubMed1991

Computer applications in diagnostic imaging.

This article has introduced the nature, generation, use, and future of digital imaging. As digital technology has transformed other aspects of our lives--has the reader tried to buy a conventional record album recently? almost all music store stock is now compact disks--it is sure to continue to transform medicine as well. Whether that transformation will be to our liking as physicians or a source of frustration and disappointment is dependent on understanding the issues involved.

Diagnostic Imaging↗