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PubMedDate not supplied

International education and reflection: transition of Swedish and American nursing students to authenticity.

Reflection, a process grounded in distancing from the self to enhance self-awareness, can be used as a pedagogic activity to promote students' transition to a greater authenticity and professionalism and, therefore, improve patient care and nursing practice. In this international educational project (implemented in 2001) using interactive videoconferencing technology (IVC), Swedish and U.S. nursing students and faculty incorporated reflective journaling, drama in education, photolanguage, and off-air meeting discussions to enhance personal and professional development. Highlights from the literature, a description of the project, and student and faculty appraisals are presented.

Attitude of Health Personnel↗
PubMed2003

New visual technologies in court: directions for research.

Litigation is being transformed by new visual communication technologies, including videoconferencing, PowerPoint, and computer animations. Yet the effects of these visual technologies on legal decision making are largely unknown. In order to understand better the most pressing issues surrounding technology in the courtroom, psychologists, lawyers, and representatives from technology companies and funding agencies attended a Research Conference on Courtroom Technology organized by the Federal Judicial Center. The goals of the conference were to identify issues raised by courtroom uses of new technologies that could be illuminated by empirical research and to suggest designs and methods for conducting that research. This paper emerged from that conference. The authors provide an overview of considerations that should guide research in this area, including a framework that takes into account features of the technology, the audience, and the legal strategy of the user of the technology. They outline a paradigm for conducting such research, illustrate it with several possible empirical studies of varying levels of experimental and conceptual complexity, and identify directions for subsequent research.

Audiovisual Aids↗
PubMed2002

How to develop a low cost, in-house distance learning center for continuing medical education. Part I.

Continuing medical education is essential to improve the quality of health care. Residential courses are expensive for small hospitals but videoconferencing is an economical alternative. Models of distance learning centers are described along with an explanation of INTERNET basics and the use of INTERNET protocol for local area networks (INTRANET). Hardware, software and other technology required and the advantages and disadvantages of different communication methods are reported.

Costs and Cost Analysis↗
PubMed2002

How to develop a low cost, in-house distance learning center for continuing medical education. Part II.

The first part of this paper discussed the advantages and communication tools needed to create a Distance Learning Center for continuing medical education by using an Intranet or the Internet. This part continues with an explanation of the hardware, software (largely free) and human resources needed for videoconferencing as well as the costs. Suitable even for small hospitals Distance Learning Centers can be of higher quality than traditional methods of continuing medical education.

Costs and Cost Analysis↗
PubMed2004

A review of e-learning practices for undergraduate medical education.

This paper describes the findings of a literature review conducted on the current usage, lessons, and limitations of e-learning for undergraduate medical education with an emphasis on synchronous delivery in the first 2 years. The review was conducted as part of an initiative to expand the UBC undergraduate medical program in British Columbia, Canada. The 50 e-learning articles included in the review described the deployment of various types of e-learning technology and content in different settings. The seven videoconferencing articles provided product information, health education examples, and innovative approaches. The six review articles provided general guidelines and trends on e-learning in undergraduate medical education in United States and Europe. Overall, while the literature is informative, there are few reported studies that address distributed synchronous learning in these undergraduate programs.

British Columbia↗
PubMed2003

A preliminary study to investigate the potential of plasma screen technology in small group teaching for dental undergraduates.

AIM: This preliminary study was devised to ascertain whether students considered that they had an adequate view of demonstrated procedures, while observing these directly at the workbench, or indirectly on a remote plasma screen. In addition, this study sought to identify whether the students observing remotely believed that they had been disadvantaged by the inability to question the demonstrator during the demonstration. METHODS: Seventeen students divided into two groups observed a live demonstration of a laboratory technical procedure either at the workbench, or remotely at a plasma screen with the aid of video cameras. They subsequently observed a second demonstration with the roles reversed. Questionnaires were used to obtain the students' views of their ability to see and interact with the demonstrator. RESULTS: The responses of the students observing the demonstration at the plasma screen indicated that (they felt that) they were able to see the demonstration more clearly than those observing at the workbench. Those observing at the plasma screen first, in particular indicated this. The majority of students acknowledged their inability to ask questions while observing at the plasma screen. There was overwhelming support for the idea that the plasma screen should be used to complement the demonstration at the workbench. CONCLUSION: Plasma screen technology has considerable potential as a teaching tool for small groups of students, where it can afford significantly superior views of practical procedures. The students considered that the plasma screen would be best employed to provide close-up views to supplement a live demonstration. When used remotely, the apparatus may be used more satisfactorily if videoconferencing technology is also employed to facilitate interaction with the demonstrator.

Attitude↗
PubMed2003

Reliability of telemedicine for diagnosing and managing eye problems in accident and emergency departments.

OBJECTIVES: To assess the accuracy and efficiency of telemedicine in diagnosing and managing eye problems presenting to accident and emergency departments. DESIGN: A controlled trial with a face-to-face and telemedicine phases, each involving 40 patients undergoing two consecutive consultations. In the face-to-face phase, both consultations were in person; in the telemedicine phase, observer 1 used videoconferencing technology at 384 kbit/s (separate nonslit lamp-torchlight and slit lamp examinations) and observer 2 saw the patient face to face. Setting The accident and emergency department at Moorfields Eye Hospital.Participants In total, 80 consenting new patients presenting to the department. MAIN OUTCOME MEASURES: (1) Agreement levels between the two observers for each phase (judged by an independent masked investigator), (2) length of consultation, and (3) number of unnecessary recalls. RESULTS: Agreement rates were as follows. Face-to-face phase: total agreement (30/40=75%), trivial disagreement (8/40=20%), clinically important disagreement (2/40=5%). Telemedicine phase (torchlight): complete agreement (16/40=40%), trivial disagreement (20/40=50%), clinically important disagreement (4/40=10%). Telemedicine phase (slit lamp): total agreement (23/40=58%), trivial disagreement (15/40=37%), clinically important disagreement (2/40=5%). Agreement levels in the telemedicine phase with torchlight examination were significantly lower (chi(2)=10.07, P=0.007) for any disagreement. Telemedicine consultations erred on the side of clinical caution and were no slower than face-to-face consultations (mean 6 min for observer 1 in both phases). Recalls were more likely (chi(2)=5.16, P=0.02) after telemedicine consultations with torchlight only (9/40) compared with face-to-face consultations (2/40). Although there were more significant disagreements using the telemedicine, in each case the telemedicine diagnosis and management erred on the side of safety; hence, no patient would have suffered by wrong management because of the consultation using telemedicine. CONCLUSIONS: Telemedicine was found to be an accurate, safe, and efficient method of diagnosing and managing these patients, especially if slit lamp images were used. Advice using telemedicine erred on the side of caution, which resulted in more recalls.

Emergency Service, Hospital↗
PubMed2004

Evaluating clinical signs in trabeculectomized eyes.

AIM: To evaluate interobserver agreement for clinical signs in trabeculectomized eyes when examined face-to-face with slit-lamp biomicroscopy (SL) or by remote examination using telemedicine (real-time remote video imaging; TM). METHOD: A system for examining trabeculectomized eyes was devised and validated. A prospective randomized interobserver agreement study was then undertaken to compare standard SL biomicroscopy and TM. Remote examination was performed using a 384 kbps Sony 5100 videoconferencing system. Three ophthalmologists each examined 40 eyes of 40 patients, who had previously undergone trabeculectomy. In rotation, two examiners used SL biomicroscopy. The third examined the eye remotely by TM. Analysis was performed to determine the variability in clinical signs and the presence or absence of systematic bias between ophthalmologists and examination methods. RESULTS: High levels of agreement were observed for paired examinations by SL biomicroscopy (SL/SL) for bleb vascularity (score range 0-10) with no systematic bias. Paired examination by SL and TM (SL/TM) also showed good levels of agreement for bleb vascularity, although the spread of disagreement was wider (95% limits of agreement 2.57 vs 2.98 (P=0.054)). For anterior chamber depth, observers agreed within +/- 10% of anterior chamber depth for 68% of eyes (SL/SL) and 51% of eyes (SL/TM) (P=0.68). Agreement was 'good' for wall thickness (kappa=0.63 +/- 0.08), bleb height (kappa=0.67 +/- 0.1), and the existence of bleb leak (kappa=0.63 +/- 0.19), but poor for bleb morphology (kappa=0.26 +/- 0.12). For the SL/TM comparison, agreement was fair for wall thickness (kappa=0.39 +/- 0.13), poor for bleb height (kappa=0.17 +/- 0.12), good for bleb leak (kappa=0.56 +/- 0.19), and fair for bleb morphology (kappa=0.31 +/- 0.12). Microcysts were not reliably detected using either technique. CONCLUSION: SL biomicroscopy and TM telemedicine examination may permit reliable clinical assessment of trabeculectomized eyes. However, remote examination with TM is more limited with respect to assessing bleb height and bleb wall thickness. The assessment of bleb morphology and microcysts was unreliable with both instruments. We propose that TM examination of trabeculectomized eyes appears safe and appropriate in situations where face-to-face examination by an ophthalmologist is not practical.

Anterior Chamber↗
PubMed2006

An Internet-based telerehabilitation system for the assessment of motor speech disorders: a pilot study.

PURPOSE: This pilot study explored the feasibility and effectiveness of an Internet-based telerehabilitation application for the assessment of motor speech disorders in adults with acquired neurological impairment. METHOD: Using a counterbalanced, repeated measures research design, 2 speech-language pathologists assessed 19 speakers with dysarthria on a battery of perceptual assessments. The assessments included a 19-item version of the Frenchay Dysarthria Assessment (FDA; P. Enderby, 1983), the Assessment of Intelligibility of Dysarthric Speech (K. M. Yorkston & D. R. Beukelman, 1981), perceptual analysis of a speech sample, and an overall rating of severity of the dysarthria. One assessment was conducted in the traditional face-to-face manner, whereas the other assessment was conducted using an online, custom-built telerehabilitation application. This application enabled real-time videoconferencing at 128 kb/s and the transfer of store-and-forward audio and video data between the speaker and speech-language pathologist sites. The assessment methods were compared using the J. M. Bland and D. G. Altman (1986, 1999) limits-of-agreement method and percentage level of agreement between the 2 methods. RESULTS: Measurements of severity of dysarthria, percentage intelligibility in sentences, and most perceptual ratings made in the telerehabilitation environment were found to fall within the clinically acceptable criteria. However, several ratings on the FDA were not comparable between the environments, and explanations for these results were explored. CONCLUSIONS: The online assessment of motor speech disorders using an Internet-based telerehabilitation system is feasible. This study suggests that with additional refinement of the technology and assessment protocols, reliable assessment of motor speech disorders over the Internet is possible. Future research methods are outlined.

Adolescent↗
PubMed1998

International collaboration in the development of postgraduate research training (692).

Research training leading to a higher degree can be difficult for those who live in countries where advanced educational facilities are not yet available, since it may involve translation of a whole family to a foreign country with resultant language, financial and cultural problems. There are special difficulties for females and those of the Moslem faith, who may have been married early and already have a family by the time of initial graduation. There may also be cultural difficulties preventing overseas study for the unmarried female. This paper describes a flexible approach developed by the University of Aberdeen in association with the Ministry of Health in Kuwait. This was an MSc course on the process of continuous quality assurance in medical practice which was based on the concept that research training was the best means of evaluating and measuring quality. The students were finally assessed on the quality of their research dissertation. The course, which was part-time, and thus lasted for 2 years, required them to spend 12 weeks in each of two successive summers in Aberdeen. The subject chosen for each dissertation was related to the work area of the candidate and was studied in the country of origin with the help of periodic visits by the supervisors. The results were surprisingly successful since the students became highly motivated by the problems of their own country and were encouraged by their colleagues at home. The process could have been even more successful if videoconferencing facilities had been available at both the Aberdeen and Kuwait centres. It is concluded that a more flexible approach by western universities would result in an increase in both the quantity and the quality of postgraduate study.

Education, Medical, Continuing↗
PubMedDate not supplied

Interactive stereotaxic teleassistance of remote experts during arthroscopic procedures.

This article describes the technical setup for stereotaxic telesurgical assistance for arthroscopic procedures. It also outlines the current state, limitations, and feasibility of this technical development. Teleassistance or teleconsultation implemented in endoscopic or arthroscopic procedures have not yet been reported. In this study, 7 computer-assisted arthroscopies of the temporomandibular joint were supported by extramural experts via interactive stereotaxic teleconsultation from distant locations. The external experts were supplied with close to real-time video, audio, and stereotaxic navigation data directly from the operation site. This setup allows the surgeons and external experts to interactively determine portals, target structures, and instrument positions relative to the patient's anatomy and to discuss any step of the procedures. Optoelectronic tracking interfaced to computer- based navigation technology allowed precise positioning of instruments for single or multiple temporomandibular joint punctures. The average error of digitizing probe measurements was 1.3 mm (range, 0.0 to 2.5 mm) and the average standard deviation was 0.7 mm (range, 0.4 to 0.9 mm). Evaluation of the reliability and accuracy of this technique suggests that it is sufficient for controlled navigation, even inside the small temporomandibular joint, a fact that encourages further applications for arthroscopy in general. The minimum requirement for high-quality video transmission for teleassisted procedures are integrated services digital network (ISDN) connections. Conventional ISDN-based videoconferencing can be combined with computer-aided intraoperative navigation. Transmission control protocol/internet protocol (TCP/IP)-based stereotaxic teleassistance data transmission via ATM or satellite seem to be promising techniques to considerably improve the field of arthroscopy.

Aged↗
PubMed1996

[Teleradiology: use of multimedia PC for access to electronic patient records and teleconsultation].

A PC-platform is presented using internet technology on Ethernet (local) or ISDN (external) for access to digital hospital infrastructures comprising electronic multimedia patient records integrating information systems of all clinical departments. In addition, a videoconferencing system is implemented for teleconsulting, and a document camera allows transmission of analogue data. In combination with the multimedia-PC. Ethernet as well as ISDN offer satisfying performance for transmission of medical data including images. In 20 cases, visualisation of the electronic patient record, an average CT with report and 58 GIFF Images', or transfer of an ACR-NEMA file from CT, took seconds (Ethernet) or up to 3.5 minutes (ISDN - 58 CT images and report).

Computer Communication Networks↗
PubMed1998

[Teleconsultation network for ophthalmology--experiences and results].

MOTIVATION: Telemedical services for ophthalmology are developed within the OPHTEL project, which has been funded by the European Union and by the Bavarian government in the Bavaria-online initiative. METHODS: Seven private ophthalmologists, one university eye clinic, one clinical Diabetes center and an informatics research institute are connected within a teleconsultation network. Asynchronous (based on Internet E-Mail) and synchronous (based on ISDN-mediated videoconferencing tools) types of teleconsultations are realized. RESULTS: 86 teleconsultations (62 asynchronous, 23 synchronous) took place within the first 10 months. Complex and rare eye diseases as well as interdisciplinary questions (ophthalmology--diabetology) are the main area of medical communication interest. Legal and security problems are discussed. CONCLUSIONS: Telemedical services must be understood as a complete process of medical care on the basis of modern communication technologies, which influences also the management of this process.

Computer Communication Networks↗
PubMed2002

Combining quantitative and qualitative research to engage stakeholders in developing quality indicators in general practice.

In 2000, the Newcastle Institute of Public Health (NIPH) undertook a project that aimed to review, identify and where necessary, develop a range of indicators of quality service provision in general practice. We describe the way in which quantitative and qualitative research methods (including a Delphi style survey) were combined to investigate consensus amongst stakeholders in defining quality indicators. Over 500 general practice stakeholders were consulted. They included general practitioners (GPs) and their representative groups, academics, policy makers, and consumers. Several important lessons were learnt from the process, including the importance of involving a broad representative group of stakeholders, informing workshop participants in advance, providing adequate response times for the Delphi surveys and using videoconferencing technologies.

Aged↗
PubMed2002

The fetal tele-ultrasound project in Queensland.

The need for access to tertiary centre experts for those living in rural and remote areas of Queensland is well recognised. With an estimated population of 3.3 million people of whom 55% live outside the capital city, Queensland is ideally suited to telemedicine, as it provides a potential opportunity to improve access to specialist care. Congenital fetal abnormalities are the major causes of perinatal morbidity and mortality. With only two Maternal Fetal Medicine Specialists in Queensland located in a major teaching hospital in Brisbane, the opportunity to use videoconferencing technology to develop a tertiary level tele-ultrasound service presented a challenge--that is, to find a technical and clinical solution to enable such a service. We report on some of our practical experiences and difficulties in establishing such a service.

Congenital Abnormalities↗
PubMed2005

Designing and implementing E-health Applications in the UK's National Health Service.

Telemedicine/e-health applications have the potential to play an important role in Britain's National Health Service (NHS), including the NHS in Scotland. The Scottish Telemedicine Action Forum (STAF) was established by the Scottish Executive Department of Health in 1999 to take a range of applications, targeted on national priorities, into routine service. In the process it has provided insights into how advanced information and communication technologies (ICTs) can be moved from the research stage into routine service. In this article four of the projects are described and analysed focusing on the key issues that have emerged as critical for carrying projects successfully through to implementation in service as follows: 1. A multisite videoconferencing network linking 15 minor injury units to the main accident and emergency (A&E) centre. 2. A single-site neonatal intensive care "cotside" laptop system to assist communication between parents and clinical staff. 3. A single-site outpatient chronic disease management system. 4. A multisite software audit tool to support the care of cleft lip and palate patients from birth onward.

Humans↗
PubMedDate not supplied

Information and communication systems for the assistance of carers based on ACTION.

Recent advances in telecommunication technologies allow the design of information and communication systems for people who are caring for others in the home as family members or as professionals in the health or community centres. The present paper analyses and classifies the information flow and maps it to an information life cycle, which governs the design of the deployed hardware, software and the data-structure. This is based on the initial findings of ACTION (assisting carers using telematics interventions to meet older persons' needs) a European Union funded project. The proposed information architecture discusses different designs such as centralized or decentralized Web and Client server solutions. A user interface is developed reflecting the special requirements of the targeted user group, which influences the functionality and design of the software, data architecture and the integrated communication system using video-conferencing. ACTION has engineered a system using plain Web technology based on HTML, extended with JavaScript and ActiveX and a software switch enabling the integration of different types of videoconferencing and other applications providing manufacturer independence.

Adult↗
PubMed1999

Developing a video-mediated communication system for hospitalized children.

When a student is away from school for an extended time due to illness, he/she is provided with a tutor or access to in-hospital classrooms to keep up with his/her studies. This isolates the child from normal classroom experiences. A remote-control videoconferencing system (VCS), P.E.B.B.L.E.S.trade mark (Providing Education by Bringing Learning Environments to Students), was developed to allow a student access to his/her regular classroom from the hospital. Remote control is provided by a game pad, which allows the student to direct the system. The first iteration, P.E.B. B.L.E.S. I, tested feasibility. The design of P.E.B.B.L.E.S. II provides an integrated version of the system with user interface aimed at children. Four studies examined its efficacy in allowing a student to participate in typical classroom activities and in providing him/her a sense of presence in the classroom. Results indicate that the system can be used with relatively few errors when set to perform the majority of required activities. The study-participants reported positive experiences using the system, and remote users appeared to have a sense of presence in the classroom.

Attitude↗