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PubMed2000

Web-based continuing medical education (I): field test of a hybrid computer-mediated instructional delivery system.

BACKGROUND: The Internet and the World Wide Web (the Web) present exciting new possibilities for distributing educational materials at a distance and facilitating collaborative learning among geographically isolated physicians. This article provides a brief overview of the Web as an instructional delivery platform and discusses its strengths and weaknesses as a potential medium for enhancing distance learning opportunities for rural and remote physicians. It also describes an innovative hybrid instructional delivery model that was field tested by the Telemedicine Centre to determine its efficiency and effectiveness for providing Web-based instruction. A hybrid model merges the Web and CD-ROMs (compact disk read-only memory) to use several of the more valuable instructional components of Web-based education (i.e., multimedia, interactive forms, hypermedia, and computer-mediated communications). The results of the field test indicate that the hybrid delivery model was an efficient means for delivering computer-mediated continuing medical education instruction on dermatologic office procedures to a group of rural physicians in low telecommunication bandwidth regions.

CD-ROM↗
PubMed2003

Videoconferencing for practice-based small-group continuing medical education: feasibility, acceptability, effectiveness, and cost.

INTRODUCTION: Small-group, practice-based learning is an effective and well-accepted method of continuing medical education (CME). However, one limitation is that many physicians work in communities with fewer than the minimum number recommended for an effective learning group. Videoconferencing has the potential to remove this limitation. The purpose of this study was to evaluate the feasibility, acceptability, effectiveness, and cost of conducting practice-based, small-group CME learning by videoconference. METHODS: Through a videoconferencing link, 10 learners in three communities were guided through four practice-based learning modules by a trained facilitator at a fourth site. Data were collected through evaluation questionnaires, direct observation by the research team, pre- and post-knowledge tests, a focus group, and an interview. RESULTS: A total of 31 learners participated in the four modules. Videoconferencing was generally well accepted by learners. The facilitator and research team observers noted that muting microphones, video quality, audio quality, and audio lag all somewhat hindered discussion. Overall, the facilitator found moderating by videoconference only slightly more difficult than a face-to-face session. There was evidence of knowledge gain, with post-test scores being 20% higher than pretest scores (p = .006). Learners reported nine practice changes from taking the modules. At commercial rates, telecommunications costs per videoconferenced module were approximately CAN$1,200. DISCUSSION: Videoconferencing has the potential to bring the benefits of small-group, practice-based learning to many physicians; however, strict attention to videoconferencing techniques is required. Cost is also an important consideration.

Attitude of Health Personnel↗
PubMed1982

A hematology data-logging terminal.

Intended as a link between a central analysis facility and remote microscope analyzers at international sites, a data-logging terminal has been developed which exploits basic analyzer control and data acquisition capabilities. The terminal depends on the analyzer's ability to assimilate, interpret, and respond to external commands transferred through its standard communications interface. Within the limits of the analyzer's high-level control language, the data-logging terminal is able to direct microscope operation and data acquisition as well as to initiate algorithms. Internal instrument algorithms can then establish and maintain focus, acquire specified objects, direct various scene segmentation sequences, and execute feature extractions. The data-logging terminal can thus command the analyzer to find scenes of interest and extract data from them. User access to a limited instrument operating interface is provided through its keyboard and alphanumeric display. The terminal can also request and receive image, feature, or count data over the communications interface. Such data are recorded, together with identifiers entered through the keyboard, onto diskettes which may be transferred by mail or telecommunications for processing with the image analysis and pattern recognition techniques available at the central analysis facility. Anticipated applications include evaluation of sample-preparation techniques, correlation of image data with sampling conditions, training of special classifiers, and analysis of instrument performance.

Computers↗
PubMed2001

Administering cognitive-behavioral therapy for bulimia nervosa via telemedicine in rural settings.

OBJECTIVE: This report describes the therapy of 2 women with bulimia nervosa who were treated using cognitive-behavioral therapy delivered via telemedicine. METHOD: The telecommunication link was established using a 128-Kbps ISDN switchable data line. RESULTS: Both cases were treated successfully and were doing well at 1-month follow-up. DISCUSSION: These cases illustrate that this methodology may make it possible to deliver manual-based psychotherapies to patients with eating disorders in remote areas.

Adult↗
PubMedDate not supplied

The use of computers and the Internet as a source of health information for people with disabilities.

It becomes increasingly obvious that computers and the Internet will play a prominent role in healthcare in the 21st century in America. The use of these tools in telecommunications technology to inform and educate has resulted in the emerging field of interactive health communication (IHC). The value of this new field is heightened by its potential to make health-related information and services more accessible to vulnerable populations such as people with disabilities. The assessment of user needs is one of the first activities necessary in the development of IHC applications. This article reports our findings from a survey conducted as the first step in developing a program of interactive health applications for people with disabilities resulting from brain and spinal cord injuries. A rehabilitation center conducted a 3-year retrospective survey of patients who had completed rehabilitation from brain or spinal cord injury. The survey found that 73% of respondents surveyed had access to and used computers, and 68% had access to the Internet. Our findings show that people with disabilities are using computers and the Internet, suggesting these tools' potential as a medium for the dissemination of health-related information and services for this underserved population. Further findings and key issues related to IHC design and application are discussed.

Adolescent↗
PubMed2001

The NMR reciprocity theorem for arbitrary probe geometry.

It is shown that the NMR reciprocity theorem is a variant of a problem considered by Lorentz in 1895. This formulation is quite general and applies to electric-dipole-based as well as coil-based or resonator-based magnetic resonance probes. The reasoning is related to, but different from, the proof of the reciprocity theorem for radiofrequency networks and for transmit/receive antenna systems in telecommunications. The signal-to-noise ratio of the NMR experiment is also discussed in very general terms.

Journal Article↗
PubMed2002

Assessment of feasibility of workplace health promotion.

BACKGROUND: A simple empirically based method for assessment of the feasibility of workplace health promotion programs is described, focusing on cancer hazards (lifestyles, workplace hazards, deficient early detection). The basic components of feasibility are addressed: extent of hazards; needs of employees for hazard reduction and acceptability of WHP; and social context. METHODS: The procedure consists of six modules: guidelines on feasibility assessment; employee questionnaire; interview checklists for probing attitudes of management and partners (social context); data form; debriefing; and assessment of feasibility. Pretesting was completed in 16 workplace communities representing industry, construction, transport, telecommunications, health care, lodging and catering, teaching, and municipality jobs in five countries; a total of 1,085 subjects completed the employee questionnaire on health hazards, needs, and acceptability. RESULTS: The method demonstrated its utility in obtaining and summarizing the necessary data. Feasibility was assessed for the 16 test communities. CONCLUSION: The procedure can be customized; it has a high degree of face validity or understandability, and it is applicable in a wide variety of settings.

Attitude to Health↗
PubMed1993

Etiology of melanoma.

Although the precise etiology of melanoma remains unknown, much data link sunlight to melanoma. The imperfect evidence associating sun exposure (particularly UVB radiation) with melanoma emerges from human data, obviating problems inherent in extrapolation from animal and other models. However, the mechanism by which sunlight might possibly initiate or promote melanoma remains obscure. Some clarification should emerge from the potential isolation of genes that carry susceptibility to melanoma in families prone to the disease; such work could serve as a basis to distinguish genetic and environmental influences in melanoma [167]. Continued studies of faulty DNA repair in XP patients may elucidate the steps in mutagenesis and carcinogenesis. Future case-control studies must address the limits on the accuracy of recall and the limits on statistical methods to separate the cluster of phenotypic risk needed in determining biologically effective dose. Animal and in vitro studies must contribute more insight. Further research in the South American opossum models appears promising [72]. Although ozone depletion has been documented, there has been little definitive evidence of subsequent increase of UVB at the Earth's surface. Nevertheless, the threat posed by ozone depletion deserves continued environmental action and public education. The role of precursor lesions, particularly dysplastic nevi/atypical moles, must be clarified with future research. The distribution of melanoma among various work forces suggests that occupational risk factors may play an important role in the etiology of this disease [168-170]. The consistent reports of excess melanoma among accountants, clerical workers, professional workers, and teachers deserve further study. Furthermore, evidence of excesses in printing and press, petrochemical, and the telecommunications industries require follow-up. Carefully planned studies that account for nonoccupational risk factors are recommended. Research over the last four decades has brought much information about melanoma etiology. More work is needed to learn the precise cause and ultimately to prevent avoidable mortality from malignant melanoma.

Animals↗
PubMed1986

Does your hospital need a robot or a management trainer? On advising the health care executive who is interested in innovation, but uncommitted to it.

Executives of small hospitals and home health services have heard that this is the Age of Computers, Telecommunications, Robotics, and Gene Engineering, and they wonder if their organizations might benefit from the high technology and advanced management tools employed by big corporations and "leading edge" hospitals. But they are too tired and busy to greatly expand their technical/managerial expertise, especially since there are so many choices among possible innovations, ranging from robotics to management training, each choice demanding different new expertise, and each requiring an investment of time and energy. We helped several health care executives to identify their options for innovation. We offered a scoring scheme to sort out the innovation options (a simple but effective way to decide what innovation would be "right" for their organization), and a simple, "back of the envelope" tutorial on robotics in health care. The principle is to allow the administrators to make a quick evaluation of the paths they might wish to travel. Our point here is that for every "natural-born" innovator, there must be dozens of interested but uncommitted persons who need some gentle, simple help. To the extent that the diffusion of medical systems depends on a mass market, these fence-sitters must receive help and guidance.

Automation↗
PubMed1996

Information, communication and networks in international migration systems.

"This paper focuses on the role of information and communication in international migration by means of a survey which covers economic and broader perspectives, both at the micro and macro levels. The human capital model of migration is reviewed and the likely impact of recent and anticipated developments in telecommunications technology is noted. The job search model is reformulated in the context of international migration but extensive modification is required to describe the potential sampling of job offers and other informational needs of international migrants. It is argued that spatial selectivity is to a large extent influenced by migration networks in which information flows play a critical role. This is further elucidated by offering an analytical framework based on the systems approach to migration."

Communication↗
PubMed1986

Implementation of an advanced clinical and administrative hospital information system.

Over the last six years since University Hospital opened, the University Hospital Information System (UHIS) has continued to evolve to what is today an advanced administrative and clinical information system. At University Hospital UHIS is the way of conducting business. A wide range of patient care applications are operational including Patient Registration, ADT for Inpatient/Outpatient/Emergency Room visits, Advanced Order Entry/Result Reporting, Medical Records, Lab Automated Data Acquisition/Quality Control, Pharmacy, Radiology, Dietary, Respiratory Therapy, ECG, EEG, Cardiology, Physical/Occupational Therapy and Nursing. These systems and numerous financial systems have been installed in a highly tuned, efficient computer system. All applications are real-time, on-line, and data base oriented. Each system is provided with multiple data security levels, forward file recovery, and dynamic transaction backout of in-flight tasks. Sensitive medical information is safeguarded by job function passwords, identification codes, need-to-know master screens and terminal keylocks. University Hospital has an IBM 3083 CPU with five 3380 disk drives, four dual density tape drives, and a 3705 network controller. The network of 300 terminals and 100 printers is connected to the computer center by an RF broadband cable. The software is configured around the IBM/MVS operating system using CICS as the telecommunication monitor, IMS as the data base management system and PCS/ADS as the application enabling tool. The most extensive clinical system added to UHIS is the Physiological Monitoring/Patient Data Management System with serves 92 critical care beds. In keeping with the Hospital's philosophy of integrated computing, the PMS/PDMS with its network of minicomputers was linked to the UHIS system. In a pilot program, remote access to UHIS through the IBM personal computer has been implemented in several physician offices in the local community, further extending the communications horizons of University Hospital's Information System. The implications of remote access to PDMS through the IBM PC emulating a Siemens Model 420 Patient Data Management Terminal are being examined.

Artificial Intelligence↗
PubMed1995

Health Care Financing Administration (HCFA) and reimbursement in telemedicine.

Telemedicine has real potential to improve the availability of services and advice of medical specialists to primary care practitioners and their patients. Use of the term "telemedicine" for the purposes of this article will refer to two-way, interactive video systems over which medical consultation takes place. This does not include the use of telecommunications technology to transport still images, particularly radiologic images, from one site to another. We are quite aware that teleradiology and telepathology is already in common use in many sites. We are currently exploring the question of quality standards for teleradiology in addition to other forms of telemedicine.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1995

The role of telemedicine in disaster medicine.

Telecommunications from telephone and radio to two-way audio, video, facsimile (fax), and digital imaging via satellite transmission have been used in responses to disasters. Current and rapidly emerging communications technology offers the prospect of enormously expanded and more efficient application in predisaster, acute, and postdisaster rehabilitation activities. A survey of present and potential roles for telemedicine in disaster medicine will be presented with particular focus on initial on-going medical needs assessment, prevention programs, and emergency assistance for provision of emergency care of victims, care for other survivors, and public health and sanitation services. Attention will also focus on telemedicine in education and training, disaster response exercises, development of comprehensive plans, and research. Finally, the essential relationship between the routine utilization of telemedicine in predisaster health care and effective employment in disaster situations will be discussed.

Disaster Planning↗
PubMedDate not supplied

The effects of microwave radiation from mobile telephones on humans and animals.

This article presents a brief review of current mobile telecommunications systems, which represent a source of microwave pollution of the environment. It has been shown that the biological effects of radiation from cellular telephones involve the time factor for the real effects on the body. Results of studies of the biological effects of low-intensity modulated microwave irradiation, including that from cellular telephones, lead to the conclusion that irradiation does not have pathological effects on the body, but does induce the usual non-specific adaptive reactions. It is only in conditions of serious derangements of the immune system and prolonged exposure with cumulative effects that cancerogenic effects can occur in the body; as in other examples of external influences on the body, this is mediated by disruption of the balance between cellular repair systems and damage, the latter being favored. Several methods for studying low-intensity microwave irradiation are presented; these can be used for investigating its influence on psychophysiological functions in humans.

Animals↗
PubMed1995

Sleep problems and their correlates in a working population.

OBJECTIVE: To measure the prevalence of sleep problems in a working population and examine their association with health problems, health-related quality-of-life measures, work-related problems, and medical expenditures. Also, to explore the usefulness of a sleep-problems screen for mental health conditions and underlying sleep disorders. DESIGN: Cross-sectional survey administered via voice mail and telephone interview. SETTING: A San Francisco Bay Area telecommunications firm. PARTICIPANTS: Volunteer sample of 588 employees who worked for a minimum of six months at the company and were enrolled in its fee-for-service health plan. MEASUREMENTS AND MAIN RESULTS: Thirty percent of respondents reported currently experiencing sleep problems and were found to have worse functioning and well-being (general health, cognitive functioning, energy), more work-related problems (decreased job performance and lower satisfaction, increased absenteeism), and a greater likelihood of comorbid physical and mental health conditions than were the respondents who did not have sleep problems. They also demonstrated a trend toward higher medical expenditures. CONCLUSIONS: Self-perceived sleep problems were common among the respondents and were associated with poorer health and health-related quality of life. A single question about sleep problems may serve as an effective screen for identifying primary care patients with mental health problems, as well as underlying sleep disorders.

Absenteeism↗
PubMed2001

Teledermatology in New Zealand.

BACKGROUND: Teledermatology is the delivery of specialist dermatological services at a distance. It has become possible because of technological advances in digital imaging and telecommunications. Consultations may be "interactive" using video-conferencing equipment or "store-and-forward" using prerecorded text and images. The best method to deliver teledermatology services is unknown. OBJECTIVE: Studies were designed to determine (a) if it was possible to diagnose and manage skin diseases using video-conferencing equipment, (b) if teledermatology was acceptable to patients and medical practitioners, and (c) whether it offered any economic advantages. We have also compared interactive and store-and-forward techniques. METHOD: The trials were conducted in collaboration with the Institute of Telemedicine & Telecare, Queen's University, Belfast, as part of the UK Teledermatology Trials. RESULTS: The trials have involved more than 300 teledermatology consultations. Having established that a diagnosis can be made in more than two-thirds of the cases, the majority of video consultations have resulted in satisfactory management, with only small numbers of patients requiring face-to-face review. Teledermatology is generally popular with patients and can save them considerable time and money. Routine clinics continue in three centers. We have found that effective store-and-forward teledermatology requires very good images and comprehensive historical referral data.

Attitude of Health Personnel↗
PubMed1992

Teleradiology via narrow-band integrated services digital network (N-ISDN) and Joint Photographic Experts Group (JPEG) image compression.

The importance of remote access to both radiological images and medical information has stimulated many demonstration projects that use a variety of telecommunications providers' offerings. Teleradiology, through modest cost channels, can achieve adequate response times using a combination of narrow-band integrated services digital network (N-ISDN) and data compression. A demonstration project, developed in collaboration with Southwestern Bell Technology Resources, Inc, uses the aggregate bandwidth of two B channels (achieving a rate of 120 kilobits per second) and a block-oriented discrete cosine transform compression/decompression implementation based on the Joint Photographic Experts Group Standard for Still Image Compression. System response measurements for an Inquiry and Display Station accessing the Mallinckrodt Institute of Radiology's Radiology Image and Information Management Testbed via the N-ISDN connection show response times to be within 20 seconds. Viewing applications have been shown at sites within St Louis and at Radiological Society of North America, 1990, in Chicago.

Computer Communication Networks↗
PubMed1999

Meta-manager: a requirements analysis.

The digital imaging network-picture-archiving and communications system (DIN-PACS) will be implemented in ten sites within the Great Plains Regional Medical Command (GPRMC). This network of PACS and teleradiology technology over a shared T1 network has opened the door for round the clock radiology coverage of all sites. However, the concept of a virtual radiology environment poses new issues for military medicine. A new workflow management system must be developed. This workflow management system will allow us to efficiently resolve these issues including quality of care, availability, severe capitation, and quality of the workforce. The design process of this management system must employ existing technology, operate over various telecommunication networks and protocols, be independent of platform operating systems, be flexible and scaleable, and involve the end user at the outset in the design process for which it is developed. Using the unified modeling language (UML), the specifications for this new business management system were created in concert between the University of Arizona and the GPRMC. These specifications detail a management system operating through a common object request brokered architecture (CORBA) environment. In this presentation, we characterize the Meta-Manager management system including aspects of intelligence, interfacility routing, fail-safe operations, and expected improvements in patient care and efficiency.

Arizona↗