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CoMed: a real-time collaborative medicine system.

CoMed is a prototype of a real-time collaborative medicine system that allows medical specialists to share patient records and to communicate with each other on the Internet. CoMed consists of a multimedia medical database containing relevant information about laryngeal diseases and a real-time collaboration system including a teleconferencing system, a whiteboard and a chatting system. CoMed is web-based. We adopted the object database O2 and CORBA technologies for the multimedia medical database. Therefore, our system can provide the flexibility, extensibility and location transparency of patient databases. We developed a SeeYou Active X control for the teleconferencing system and a Java applet for the whiteboard and chatting system. CoMed improves the efficiency of the overall system by separating the servers on a UNIX machine and a Windows NT machine. CoMed can be utilized for stand-alone research, for collaborative consultations among medical specialists and for a telemedicine in participation with the patients and medical specialists. Our system can be extended easily into other types of the collaborative systems, such as collaborative distance learning, collaborative science system, etc.

Humans↗

A virtual classroom for undergraduate periodontology: a pilot study.

The Integrated Distributed Learning Environments or virtual classrooms constitute a new promising structure in education of health care personnel. A virtual classroom was developed aiming to teach periodontology to an international group of 28 dental students using a problem-based learning (PBL) approach. The course was web-based and included synchronous and asynchronous communication, on-line libraries and multimedia material. Students were organised in 4 independent groups and each group was appointed a tutor. The results of the study indicate that one of the most positive effects students experienced was competence in using the computer. They also rated highly the use of multimedia for learning of clinical procedures. It was found that web boards and email were too slow to allow group work in the virtual classroom. Real time communication programs were found to be superior for problem discussion and hypothesis formulation. However, email and the web board played a significant role during certain steps of the PBL method. The students expressed a positive attitude for the combined use of network-based learning and problem-based education. Our present experience suggests that distance learning should be organised with a mixture of different media, allowing communication of knowledge and skills between the resources and the students, as well as cooperation between the students. Computer literacy among teachers and students is limited and should be enhanced. Finally, personal contact between the resource persons and the students before the distant learning course commences helps the learning process.

Attitude↗

Information technology in dental education.

The use of information technology in dental education is continually increasing. In this article, IT is defined, and its uses in teaching and learning explored. Examples of the appropriateness of multimedia teaching in dental education are given. Successful multimedia teaching, especially in clinical settings, relies on the proper use of IT and an implementation strategy. The applications of IT to curriculum development, computer-assisted learning (CAL), educational administration, dental practice, hospital administration, and clinical research are also considered.

Computer-Assisted Instruction↗

User-friendly technology to help family carers cope.

BACKGROUND: Increases in the older adult population are occurring simultaneously with a growth in new technology. Modern technology presents an opportunity to enhance the quality of life and independence of older people and their family carers through communication and access to health care information. AIM: To evaluate the usability of a multimedia software application designed to provide family carers of the elderly or disabled with information, advice and psychological support to increase their coping capacity. INTERVENTION: The interactive application consisted of an information-based package that provided carers with advice on the promotion of psychological health, including relaxation and other coping strategies. The software application also included a carer self-assessment instrument, designed to provide both family and professional carers with information to assess how family carers were coping with their care-giving role. DESIGN: Usability evaluation was carried out in two stages. In the first stage (verification), user trials and an evaluation questionnaire were used to refine and develop the content and usability of the multimedia software application. In the second (demonstration), stage evaluation questionnaires were used to appraise the usability of the modified software application. FINDINGS: The findings evidenced that the majority of users found the software to be usable and informative. Some areas were highlighted for improvement in the navigation of the software. CONCLUSIONS: The authors conclude that with further refinement, the software application has the potential to offer information and support to those who are caring for the elderly and disabled at home.

Adaptation, Psychological↗

[Interactive computer-assisted learning program for diagnosis and therapy of recurrent laryngeal nerve paralysis].

BACKGROUND: With the increasing capacity of personal computers more and more multimedia training programs are becoming available which make use of these possibilities. Computer-based presentation is usually interesting because it is visually attractive. However, the extent to which computer-based training programs correspond to international standards of quality of software ergonomics has never been the subject of systematic research. Another question is how much these programs motivate learning and what increase in knowledge can be achieved by using them. METHODS AND RESULTS: Using a multimedia interactive training program developed in our facility, 100 medical students were asked to evaluate the program after they had been using it for about one hour. In a questionnaire they first rated suitability for the task, self-descriptiveness, controllability, conformity with user expectation, error tolerance, suitability for individualization, and suitability for learning on a bipolar scale from "---" to "+3" (in numbers 1, worst result, to 7, best result). The median values achieved were rated between 6.0 and 6.2--software ergonomic criteria of the program ranged from good to very good. The second part was a subjective evaluation of the program's ability to deliver "medical knowledge which is relevant for the exam" (median = 6.0), "knowledge about systematic procedure in medicine" (median = 5.5), "knowledge about sensible use of diagnostic methods" (median = 6.0), "knowledge about clinical methods", and "experience with selective learning" (median = 6.0). This part was also rated good to very good. The third part of the questionnaire involved a pretest-posttest comparison. Two groups of students were asked how much benefit they had achieved by using the program. It was shown that the students were able to answer the exam questions significantly better than the control questions after they had used the program. CONCLUSION: This study confirms that the interactive computer-based training program is very well suited for providing knowledge in on appealing manner in an instructional setting.

Adult↗

Students' responses to the introduction of a digital laboratory guide in medical neuroscience.

This study investigated student acceptance of a digital laboratory guide in a medical neuroscience course. The guide was created in Macromedia Authorware 5.2 by transforming a text-based lab manual into a comprehensive multimedia program. Student attitudinal survey data indicated that the guide was used primarily as a study tool at home. Some 53% of students (primarily males) used the guide for independent study exclusively, while the remainder used it for both independent and group study; 87% of the class used the guide as a routine study tool rather than as a final review for examinations. Most students perceived that the guide increased their study efficiency and lab performance while decreasing their out-of-class study time in the lab. Female students were significantly more enthusiastic about the guide's impact on their study efficiency, lab performance and laboratory study time. Gender differences in student satisfaction with and use of instructional multimedia are discussed.

Attitude of Health Personnel↗

Application of the RealAudio package to computerized medical lectures.

We created a multimedia system to computerize past lectures using RealAudio software. Physicians, medical researchers and students can browse the contents of lecture slides and handouts with synchronous audio using the Internet. The audience can easily review the most interesting parts of lectures and medical students can listen to complete medical lectures from remote sites with narration and slide depiction, whenever convenient. We have created three multimedia programs; the memorial lecture of a professor's retirement, a new method of hand washing for surgical procedures and a lecture on medical informatics. The cost of this system and the results of the evaluation by medical students are described. The ease of using this application makes it a potentially valuable tool for clinicians and researchers.

Computer-Assisted Instruction↗

New directions in medical e-curricula and the use of digital repositories.

Medical educators involved in the growth of multimedia-enhanced e-curricula are increasingly aware of the need for digital repositories to catalogue, store and ensure access to learning objects that are integrated within their online material. The experience at the Faculty of Medicine at McGill University during initial development of a mainstream electronic curriculum reflects this growing recognition that repositories can facilitate the development of a more comprehensive as well as effective electronic curricula. Also, digital repositories can help to ensure efficient utilization of resources through the use, re-use, and reprocessing of multimedia learning, addressing the potential for collaboration among repositories and increasing available material exponentially. The authors review different approaches to the development of a digital repository application, as well as global and specific issues that should be examined in the initial requirements definition and development phase, to ensure current initiatives meet long-term requirements. Often, decisions regarding creation of e-curricula and associated digital repositories are left to interested faculty and their individual development teams. However, the development of an e-curricula and digital repository is not predominantly a technical exercise, but rather one that affects global pedagogical strategies and curricular content and involves a commitment of large-scale resources. Outcomes of these decisions can have long-term consequences and as such, should involve faculty at the highest levels including the dean.

Cataloging↗

Strategic use of faculty workgroups to develop online interactive geriatric curricular modules.

Initiating a college-wide, complex multimedia approach to teaching-learning can be fraught with considerable challenges. The strategic use of faculty workgroups to maximize faculty involvement in the development and use of interactive Web-based modules was one successful approach to overcoming such challenges. Use of faculty workgroups composed of grant team faculty members and course faculty during the development process recognized the faculty's curricular and content expertise and tapped individual creativity. Other successful approaches to meeting development challenges were the inclusion of a multimedia designer in faculty workgroups, demonstrations of technology at college council meetings and the use of familiar software by faculty to communicate module design ideas. Additional practical approaches for technology teams within higher education settings are presented from both person and design perspectives.

Aged↗

User-oriented views in health care information systems.

In this paper, we present the methodology we adopted in designing and developing an object-oriented database system for the management of medical records. The designed system provides technical solutions to important requirements of most clinical information systems, such as 1) the support of tools to create and manage views on data and view schemas, offering to different users specific perspectives on data tailored to their needs; 2) the capability to handle in a suitable way the temporal aspects related to clinical information; and 3) the effective integration of multimedia data. Remote data access for authorized users is also considered. As clinical application, we describe here the prototype of a user-oriented clinical information system for the archiving and the management of multimedia and temporally oriented clinical data related to percutaneous transluminal coronary angioplasty (PTCA) patients. Suitable view schemas for various user roles (cath-lab physician, ward nurse, general practitioner) have been modeled and implemented on the basis of a detailed analysis of the considered clinical environment, carried out by an object-oriented approach.

Algorithms↗

Fingerprint multicast in secure video streaming.

Digital fingerprinting is an emerging technology to protect multimedia content from illegal redistribution, where each distributed copy is labeled with unique identification information. In video streaming, huge amount of data have to be transmitted to a large number of users under stringent latency constraints, so the bandwidth-efficient distribution of uniquely fingerprinted copies is crucial. This paper investigates the secure multicast of anticollusion fingerprinted video in streaming applications and analyzes their performance. We first propose a general fingerprint multicast scheme that can be used with most spread spectrum embedding-based multimedia fingerprinting systems. To further improve the bandwidth efficiency, we explore the special structure of the fingerprint design and propose a joint fingerprint design and distribution scheme. From our simulations, the two proposed schemes can reduce the bandwidth requirement by 48% to 87%, depending on the number of users, the characteristics of video sequences, and the network and computation constraints. We also show that under the constraint that all colluders have the same probability of detection, the embedded fingerprints in the two schemes have approximately the same collusion resistance. Finally, we propose a fingerprint drift compensation scheme to improve the quality of the reconstructed sequences at the decoder's side without introducing extra communication overhead.

Algorithms↗

Studying health information from a distance: refining an e-learning case study in the crucible of student evaluation.

PURPOSE: To present a formative evaluation of the impact of a multimedia case study as a component of a masters course in health informatics delivered by distance learning. SETTING/PARTICIPANTS/RESOURCES: First and second year health informatics students undertaking four core modules of a masters programme at the University of Sheffield. METHODOLOGY: Individual qualitative user surveys and interviews. RESULTS/OUTCOMES: Formative evaluation has played a significant role in refining the case study through its text-based, intermediate and CD-ROM based stages. Feedback from students has resulted in clarification of case study tasks, clearer definition of teaching roles and a revised approach to assessment. At the same time it has highlighted the importance of ongoing revision and maintenance in keeping the scenarios realistic and current. DISCUSSION/CONCLUSION: The multimedia case study has met many of its original aims in providing greater cohesion for core modules and encouraging greater levels of interaction and multidisciplinary collaboration.

Computer-Assisted Instruction↗

Integrated visualization of problemcentric urologic patient records.

The collision of computer-based technologies and the medical environment is resulting in an increasingly electronic multimedia patient record, consisting of not only the traditional types of data (e.g., clinic notes and laboratory reports), but also digital images (e.g., computed tomography and magnetic resonance imaging) and other visual representations of patient data (e.g., pulmonary function graphs and urodynamic charts). Given the increasing amount of data made available to physicians, it is not only critical that the totality of a patient's medical record be accessible to a clinician, but that the diverse data be integrated and presented in a manner conducive to patient management: key information should be easily discovered. This paper describes a problemcentric time-based visualization of urologic conditions, whereby a patient's medical history is automatically organized around a medical problem and presented as a graphic chronology. Urology-related data in the patient medical record is organized in accord with an expert constructed knowledge-base, and plotted on a timeline using iconic representations. The user interface permits the physician to quickly view multimedia data and to visualize relationships between events in the patient's history.

Computer Systems↗

2006 Visualization Challenge winners.

Science and the National Science Foundation announce the winners and honorable mentions in the categories of photography, illustration, informational graphics, noninteractive multimedia, and interactive multimedia in this year's Science and Engineering Visualization Challenge.

Animals↗

Current experiences with internet telepathology and possible evolution in the next generation of Internet services.

The last five years experience has definitely demonstrated the possible applications of the Internet for telepathology. They may be listed as follows: (a) teleconsultation via multimedia e-mail; (b) teleconsultation via web-based tools; (c) distant education by means of World Wide Web; (d) virtual microscope management through Web and Java interfaces; (e) real-time consultations through Internet-based videoconferencing. Such applications have led to the recognition of some important limits of the Internet, when dealing with telemedicine: (i) no guarantees on the quality of service (QoS); (ii) inadequate security and privacy; (iii) for some countries, low bandwidth and thus low responsiveness for real-time applications. Currently, there are several innovations in the world of the Internet. Different initiatives have been aimed at an amelioration of the Internet protocols, in order to have quality of service, multimedia support, security and other advanced services, together with greater bandwidth. The forthcoming Internet improvements, although induced by electronic commerce, video on demand, and other commercial needs, are of real interest also for telemedicine, because they solve the limits currently slowing down the use of Internet. When such new services will be available, telepathology applications may switch from research to daily practice in a fast way.

Humans↗

A real-time scan conversion algorithm on commercially available microprocessors.

We have developed a new ultrasound scan conversion algorithm that can be executed very efficiently on modern microprocessors. Our algorithm is designed to handle the address calculations and input and output (I/O) data loading concurrently with the interpolation. The processing unit's computing power can be dedicated to performing pixel interpolations while the other operations are handled by an independent direct memory access (DMA) controller. By making intelligent use of the I/O transfer capabilities of the DMA controller, the algorithm avoids spending the processing unit's valuable computing cycles in address calculations and nonactive pixel blanking. Furthermore, the new approach speeds up the computation by utilizing the ability of superscalar and very long instruction word (VLIW) processors to perform multiple operations in parallel. Our scan conversion algorithm was implemented on a multimedia and imaging system based on the Texas Instruments TMS320C80 Multimedia Video Processor (MVP). Computing cycles are spent only on predeterminable nonzero output pixels. For example, an execution time of 11.4 ms was achieved when there are 101,829 nonzero output pixels. This algorithm demonstrates a substantial improvement over previous scan conversion algorithms, and its optimized implementation enables modern commercially available programmable processors to support scan conversion at video rates.

Algorithms↗

Patients' need for information about cancer therapy.

PURPOSE/OBJECTIVES: To obtain detailed information about the preferences of patients with cancer and their need for information about side effects of cancer treatment to design an interactive multimedia educational program. DESIGN: Qualitative. SETTING: Regional rural academic medical center. SAMPLE: 51 patients and 14 spouses of patients who either currently were undergoing or recently had completed chemotherapy or radiation therapy for cancer. METHODS: Focus groups. MAIN RESEARCH VARIABLES: Information needs and common and distressing symptoms. FINDINGS: Patients wanted information about the process of getting treatment, specific side effects that might occur, and the impact of treatment on their lives. Patients sought information from a variety of sources, but many found that other patients were the most helpful source. Although most patients wanted as much information as possible so they would be prepared for whatever happened, some patients preferred to avoid information about possible side effects. Several obstacles related to information were reported, including access to providers, communication difficulties with providers, informational overload, and problems with retention. CONCLUSIONS: Several aspects regarding information needs confirmed previous findings, and new aspects were illuminated. This led to a conclusion that multimedia technology offered many advantages to meet these informational needs. IMPLICATIONS FOR NURSING: New approaches to patient education that will meet the needs of patients as well as clinicians and educators need to be developed.

Adult↗

Distance learning in mammographic digital image processing.

The potential of interactive multimedia and Internet technologies is investigated with respect to the implementation of a distance learning system in medical imaging. The system is built according to a client-server architecture, based on the Internet infrastructure, composed of server nodes conceptually modelled as World Wide Web (WWW) sites. Sites are implemented by integration and customization of available components. The system evolves around network-delivered interactive multimedia courses and network-based tutoring, which constitute its main learning features. This potential has been demonstrated by means of an implemented system, validated with digital image processing content, specifically image enhancement. Image enhancement methods are theoretically described and applied on mammograms. Emphasis is given in the interactive presentation of the effects of algorithm parameters on images. The system end-user access depends on available bandwidth, so high speed access can be achieved via LAN or local ISDN connections.

Biomedical Engineering↗