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PubMed2004

Universal electronic health record MUDR.

One of the important research tasks of the European Centre for Medical Informatics, Statistics and Epidemiology - Cardio (EuroMISE Centre - Cardio) is the applied research in the field of electronic health record design including electronic medical guidelines and intelligent systems for data mining and decision support. The research in the field of data storage and data acquisition was inspired by several European projects and standards, mostly by the I4C and TripleC projects. Based on experience gathered during cooperation in the TripleC project we have proposed a description of a flexible information storage model. The motivation for this effort was the large variability of the set of collected features in different departments - including temporal variability. Therefore, a dynamically extensible and modifiable structure of items is needed. In our model we use two basic structures called the knowledge base and data files. The main function of the knowledge base is to express the hierarchy of collectable features - medical concepts, their characteristics and relations among them. The data files structure is used to store the patient's data itself. These two structures can be described using graph theory expressions. Based on this model, a three-layer system architecture named "Multimedia Distributed Record" (MUDR) has been proposed and implemented. During the implementation, modern technologies such as Web Services, SOAP and XML were used. For the practical usage of EHR MUDR, an intelligent application called MUDRc (MUDR Client) was created. It enables physicians to use EHR MUDR in a flexible way. During the development process, maximum emphasis was placed on user-friendliness and comfortable usage of this application. Several methods of data entry can be used: pre-defined forms, direct entry into the tree data structure of the EHR MUDR, or automatic unstructured free-text report parsing and data retrieval. The system enables fast and simple importing and exporting of data as well. The system integrates modern multimedia formats (X-ray photos, sonography and other pictures, video-sequences, audio records) as well as progressive methods of decision support systems realized by medical guidelines and other modules.

Artificial Intelligence↗
PubMed2005

An interactive media program for managing psychosocial problems on long-duration spaceflights.

Space crews must be self-reliant to complete long-duration missions successfully. This project involves the development and evaluation of a network of self-guided interactive multimedia programs to train and assist long-duration flyers in the prevention, assessment, and management of psychosocial problems that can arise on extended missions. The system is currently under development and is intended for use both during training and on orbit. A virtual space station 3-dimensional graphic was created to serve as a portal to multimedia-based training, assessment, and intervention resources. Additionally, original content on interpersonal conflict and depression is being developed for the system. Input on the best practices for managing conflict and depression on extended missions was obtained from 13 veteran long-duration flyers, as well as from clinical experts. Formative evaluation of a prototype of the system will be conducted with 10 members of the astronaut corps. Subsequently, the content on conflict and depression will be completed, and the depression self-treatment portion will be evaluated in a randomized controlled trial. Although this study involves developing countermeasures to assist long-duration flyers, it also provides a model that could be applied in many Earthbound settings, both in operational environments and in everyday life.

Aerospace Medicine↗
PubMed1995

Interactive computer teaching/learning in the dental curriculum: partial denture design.

Interactive multimedia is an emerging industry with a broad domain. It operates from a base of computer technology to enable the production, distribution and sharing of ideas. The use of multimedia in the educational setting is in keeping with the concept of learning, rather than teaching and, with this in mind, a pilot program in interactive computer learning has been developed which is geared specifically to the requirements of junior students. The design sequence and philosophy used in this program follow the teaching at Sydney University Dental School. Its purpose is to facilitate students in mastering the technical aspects of denture framework design, leading them through a set sequence of steps from saddle identification to finish. Future plans, using more sophisticated equipment, are to develop more advanced programs for senior (fourth year) students, including applications for treatment planning and also the rudiments of osseointegrated implant work.

Australia↗
PubMedDate not supplied

Hemodialysis patient management by telemedicine: design and implementation.

The authors describe the design and implementation of a personal computer based telemedicine system for managing patients by telemedicine. With three identical systems connected by high speed T1 lines, the physician (or allied healthcare giver) can interact, by videoconferencing, and by using multimedia files, with patients at two remote hemodialysis sites. The physician is able to visualize specifically the patient's fistula/graft, and auscultate fistula, heart and lung sounds, and incorporate still pictures or audio sounds in the patient's multimedia database folder, which also contains an electronic and paperless medical record. In addition there is the capability of downloading into this database all the machine parameters during dialysis.

Databases, Factual↗
PubMedDate not supplied

[Problems in the prediction and assessment of total chemical load on the human body using computer technologies].

The paper deals with trends in the development of upto-date computer-assisted multimedia systems and defines the promising trends in their practical use in hygienic investigations. Analyzing the structure and elements of foreign computer systems has led to the conclusion that they should be adapted to the Russian conditions. The authors outlined the problems which are associated with the development of Russian multimedia systems and the adaptation of foreign ones to the Russian conditions. One of the basically important issues is a discrepancy found in the American reference doses (concentrations) and daily doses given to the population when the hygiene regulations accepted in Russia are observed.

Air Pollutants↗
PubMed1998

Towards knowledge-based retrieval of medical images. The role of semantic indexing, image content representation and knowledge-based retrieval.

Medicine is increasingly image-intensive. The central importance of imaging technologies such as computerized tomography and magnetic resonance imaging in clinical decision making, combined with the trend to store many "traditional" clinical images such as conventional radiographs, microscopic pathology and dermatology images in digital format present both challenges and an opportunities for the designers of clinical information systems. The emergence of Multimedia Electronic Medical Record Systems (MEMRS), architectures that integrate medical images with text-based clinical data, will further hasten this trend. The development of these systems, storing a large and diverse set of medical images, suggests that in the future MEMRS will become important digital libraries supporting patient care, research and education. The representation and retrieval of clinical images within these systems is problematic as conventional database architectures and information retrieval models have, until recently, focused largely on text-based data. Medical imaging data differs in many ways from text-based medical data but perhaps the most important difference is that the information contained within imaging data is fundamentally knowledge-based. New representational and retrieval models for clinical images will be required to address this issue. Within the Image Engine multimedia medical record system project at the University of Pittsburgh we are evolving an approach to representation and retrieval of medical images which combines semantic indexing using the UMLS Metathesuarus, image content-based representation and knowledge-based image analysis.

Abstracting and Indexing↗
PubMed1995

Primary care physicians' response to dissemination of practice guidelines.

BACKGROUND: Much effort has gone into producing clinical practice guidelines, but relatively few studies address dissemination issues. Unless guidelines are used, little is gained. This study evaluates the effect of three methods to disseminate asthma guidelines on physicians' behavior and attitudes toward education strategies. METHODS: Asthma guidelines were mailed to 60 physicians in three Area Health Education Centers in Arkansas. Dissemination efforts at one site featured a short summary, telephone calls by "detailing" physicians, and a continuing medical education conference. Computer strategies were used at the second site, and a multimedia approach with facsimile messages, posters, videocassettes, audiocassettes, and a continuing medical education conference was used at the third site. A fourth site with 22 participants served as a comparison. Data were collected by mailed questionnaires, outpatient chart reviews, and physician interviews. Changes between baseline and posttest assessments following a 4-month intervention were calculated for medication use, and peak flow monitoring use was compared with the control group (general linear model). Regression analyses were used to identify physician and practice factors associated with particular education techniques. RESULTS: Each site improved in the use of medications or peak flow monitoring, but none improved in all areas. The multimedia, continual reminder approach was well accepted but there was little support for the computer strategies. CONCLUSIONS: Further efforts to disseminate clinical guidelines should include a variety of formats with an emphasis on short, concise summaries and frequent reminders. Social influence appears to play a role and will be a fruitful area for further research.

Area Health Education Centers↗
PubMed1995

Increasing patient involvement in choosing treatment for early breast cancer.

BACKGROUND: This investigation examined factors affecting patient involvement in consultations to decide local treatment for early breast cancer and the effectiveness of two methods of preconsultation education aimed at increasing patient participation in these discussions. METHODS: Sixty patients with Stage I or II breast cancer (1) were pretested on their knowledge about breast cancer treatment and optimism for the future, (2) were randomly assigned to one of two methods for preconsultation education: interactive multimedia program or brochure, (3) completed knowledge and optimism measures, (4) consulted with a medical oncologist, radiation oncologist, and general surgeon, and (5) completed self-report measures assessing their involvement in the consultations and control over decision-making. The consultations were audiorecorded and analyzed to identify behavioral indicators of patient involvement (question-asking, opinion-giving, and expressing concern) and physician utterances encouraging patient participation. RESULTS: College-educated patients younger than 65 years of age were more active participants in these consultations than were older, less educated patients. In addition, patients showed more involvement when they interacted with physicians who encouraged and facilitated patient participation. The method of education did not affect patient involvement although patients tended to learn more about breast cancer treatment after using the multimedia program than after reading the brochure. CONCLUSIONS: Although patients vary in their expressiveness, physicians may be able to increase patient participation in deciding treatment by using patient-centered behavior. Also, preconsultation education appears to be an effective clinical strategy for helping patients gain an accurate understanding of their treatment options before meeting with physicians.

Adult↗
PubMed1995

Medical imaging part of multi-media.

The main objective of CEN/TC251/WG4 is to create standards for image communication to allow interoperability between heterogeneous systems in a distributed environment. The scope includes all forms of medical imaging (not only radiology) and also the image related data. The Working Group (WG) is monitoring developments in the whole field of medical imaging and multimedia, in particular image formats, image management, image processing, interface control, security and multimedia (including related standards). International co-operation is crucial resulting in one internationally acceptable standard. Technology independents for cost and evolution reasons is a perquisite of the approach, which results in a focus towards more generic standards. The work items define concrete steps, where the WG considers it important and feasible to produce a deliverable (ENV or CEN Report) within a definite time schedule. New work items will be proposed where needed. The first two Project Teams, which have finished their work, are: Medical Image and Related Data interchange format standards (WI 4.3) Profiles for Medical Image interchange (EWOS/EG MED, PTN-024). In both work items (WI), contributions from the United States and Europe are brought together. Europe is presenting a framework which includes an image communication model and a registration procedure for the objects. This 'road map' for migration towards the use of IT&T base-standards also contains a medical ISP based on ISO-IPI (Image Processing Interchange (ISO 10227)). Two other Project Teams have been launched at the beginning of 1994: Medical Image Management standard (WI 4.2) Medical Data Interchange: HIS/RIS-PACS and HIS/RIS Modality Interface (WI 4.9).(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Communication Networks↗
PubMed2005

Development of present and future of telepathology in Hungary.

Pathologists in Hungary evaluate several hundred thousand histological specimens yearly, and a second opinion is requested in 5-10 percent of cases. Application of multimedia systems (i.e. telepathology) is convenient and efficient to establish a correct diagnosis in such cases. The first telepathology connection in Hungary has been established between the 1st Department of Pathology and Experimental Cancer Research, Semmelweis University and the Department of Pathology, Central Hospital of the Ministry of the Interior. Further development occurred in the course of various projects, supported by the EU (Inter-path, Re-transplant, Be Pro): new stations were established in three university institutes and six county hospitals. Electronic fixation of the images and their transmission by telephone line (ISDN) is easily available and an important feature of the multimedia system applied in telepathology. The system used by us is suited to evaluate frozen or paraffin-embedded histologic sections, as well as immunohistochemical and cytologic specimens, if necessary supplemented with transmission of macroscopic pictures. Our experience with bilateral consultations has proven the importance of telepathology. The telepathology system established in Hungary is now ready to join the telepathology network of the EU.

Biopsy↗
PubMed2006

eLearning in education and advanced training in neuroradiology: introduction of a web-based teaching and learning application.

INTRODUCTION: New information technologies offer the possibility of major improvements in the professional education and advanced training of physicians. The web-based, multimedia teaching and learning application Schoolbook has been created and utilized for neuroradiology. METHODS: Schoolbook is technically based as a content management system and is realized in a LAMP environment. The content is generated with the help of the developed system and stored in a database. The layout is defined by a PHP application, and the webpages are generated from the system. RESULTS: Schoolbook is realized as an authoring tool so that it can be integrated into daily practice. This enables the teacher to autonomously process the content into the web-based application which is used for lectures, seminars and self-study. A multimedia case library is the central building block of Schoolbook for neuroradiology, whereby the learner is provided with original diagnostic and therapeutic data from numerous individual cases. The user can put individual emphasis on key learning points as there are various ways to work with the case histories. Besides the case-based way of teaching and learning, a systematically structured way of dealing with the content is available. CONCLUSION: eLearning offers various opportunities for teaching and learning in academic and scientific as well as in economic contexts. Web-based applications such as Schoolbook may be beneficial not only for basic university education but also for the realization of international educational programmes such as the European Master of Medical Science with a major in neuroradiology.

Computer-Assisted Instruction↗
PubMed1997

[Calibration of clinical databanks with "virtual patients"].

The scientific value of multicenter studies is still questionable, as there are no methods available that allow to determine whether in fact identical items are recorded in the same way in different centers. Subjective classifications (for example according to the New York Heart Association (NYHA)), definitions of items, documentation habits and procedures may not be comparable in different hospitals. For that reason the concept of a "virtual patient" for calibration of database systems was developed as a new methodological approach. The "virtual patients" describes a computer program that includes and uses multimedia-tools to represent an exactly defined patient. A sound card enables a patient to talk and to represent intracardial and intrapulmonary sounds. Additional information including echocardiographic sequences, perioperative video sequences, x-ray analysis, angiograms, etc. is represented in the program. Thus during the perioperative course of a patient the complete relevant pre-, intra- and postoperative information regarding the patient is provided. Any physician participating in a multicenter study is asked to record the data of this virtual patient and to store it in a database system using the sheets applied in a multicenter study. As the patient is exactly defined (virtual patient) incorrect classifications and incomplete recordings, etc. can easily be detected and discussed. The virtual patient is a tool that allows calibration of database systems by direct comparison of the documentation technique between different physicians and different hospitals participating in multicenter studies. It is thus a multimedia-instrument to support standardization and quality assurance of database systems.

Calibration↗
PubMed1994

A software engineering approach for medical workstations development.

Multimedia medical workstations represent the natural tool for accessing the hospital information system environment. They are complex medical systems that have to gather, in a single framework, a large collection of components dealing with multimedia medical objects. To remain current with both medical practice and with advances in the computer science field, they have to allow the iterative addition of new functions to the set of existing ones. In this paper, after a survey of commonly required medical workstation functional components, we shall try to discuss how a software engineering approach can streamline the development of a medical workstation. Different software engineering tools needed to build the functional components of a workstation are described. Their integration in a single dedicated environment is considered through four perspectives: data, presentation, communication and control. Benefits and limitations of an object-oriented approach are discussed.

Computer Communication Networks↗
PubMedDate not supplied

Image analysis and computer vision in medicine.

Multimedia lives with images; medical images are born from digital imaging. A physician's multimedia workstation cannot exist without tools for manipulating images, performing measurements and, generally speaking, extracting and collecting pieces of information from the available data. Image analysis and computer vision constitute a wide and rapidly evolving field. This paper is intended as an introductory document for medical imaging researchers and practitioners wishing an overview of recent developments and trends. The major lines of activities in the domain are presented, under the common framework of a processing pipeline. After a presentation of the various stages of this pipeline, current subjects of research are indicated.

Computer Graphics↗
PubMed2005

Model comparison for risk assessment: a case study of contaminated groundwater.

Many environmental multimedia risk assessment models have been developed and widely used along with increasing sophistication of the risk assessment method. Despite of the considerable improvement, uncertainty remains a primary threat to the credibility of and users' confidence in the model-based risk assessments. In particular, it has been indicated that scenario and model uncertainty may affect significantly the assessment outcome. Furthermore, the uncertainty resulting from choosing different models has been shown more important than that caused by parameter uncertainty. Based on the relationship between exposure pathways and estimated risk results, this study develops a screening procedure to compare the relative suitability between potential multimedia models, which would facilitate the reduction of uncertainty due to model selection. MEPAS, MMSOILS, and CalTOX models, combined with Monte Carlo simulation, are applied to a realistic groundwater-contaminated site to demonstrate the process. It is also shown that the identification of important parameters and exposure pathways, and implicitly, the subsequent design of uncertainty reduction and risk management measures, would be better-formed.

Animals↗
PubMed2005

Digital technologies and quality improvement in cancer surgery.

Telecommunications, multimedia and computer technologies will introduce marked changes in the management of cancer. New modalities in the representation of patient's medical records using computer technology products and services allow unlimited cross-sharing of information. Education taught through multimedia methods, and through the Internet, is available anywhere and any time just like surgical simulation, robotics and virtual reality. Thanks to computer and IT technologies, surgeons will be able to acquire, assess and validate new surgical procedures or concepts from any geographical location. Live demonstrations shared via videoconferencing facilitate mental development through the acquisition of the cognitive aspects of surgical procedures. Virtual reality is a major improvement in the processing of medical imaging. As a result, the interpretation and the simulation of therapeutic approaches to patients with cancer are facilitated through transparency, navigation and manipulation. The Internet eventually offers uninterrupted communication links between healthcare providers (teaching, training or multidisciplinary telementoring included). Computer and IT technologies will undoubtedly contribute to standardized cancer treatment modalities and determined guidelines for good clinical practice worldwide.

Computer-Assisted Instruction↗
PubMed2006

Validation of predicted exponential concentration profiles of chemicals in soils.

Multimedia mass balance models assume well-mixed homogeneous compartments. Particularly for soils, this does not correspond to reality, which results in potentially large uncertainties in estimates of transport fluxes from soils. A theoretically expected exponential decrease model of chemical concentrations with depth has been proposed, but hardly tested against empirical data. In this paper, we explored the correspondence between theoretically predicted soil concentration profiles and 84 field measured profiles. In most cases, chemical concentrations in soils appear to decline exponentially with depth, and values for the chemical specific soil penetration depth (d(p)) are predicted within one order of magnitude. Over all, the reliability of multimedia models will improve when they account for depth-dependent soil concentrations, so we recommend to take into account the described theoretical exponential decrease model of chemical concentrations with depth in chemical fate studies. In this model the d(p)-values should estimated be either based on local conditions or on a fixed d(p)-value, which we recommend to be 10cm for chemicals with a log K(ow)>3.

Environmental Monitoring↗
PubMed2004

A review of content-based image retrieval systems in medical applications-clinical benefits and future directions.

Content-based visual information retrieval (CBVIR) or content-based image retrieval (CBIR) has been one on the most vivid research areas in the field of computer vision over the last 10 years. The availability of large and steadily growing amounts of visual and multimedia data, and the development of the Internet underline the need to create thematic access methods that offer more than simple text-based queries or requests based on matching exact database fields. Many programs and tools have been developed to formulate and execute queries based on the visual or audio content and to help browsing large multimedia repositories. Still, no general breakthrough has been achieved with respect to large varied databases with documents of differing sorts and with varying characteristics. Answers to many questions with respect to speed, semantic descriptors or objective image interpretations are still unanswered. In the medical field, images, and especially digital images, are produced in ever-increasing quantities and used for diagnostics and therapy. The Radiology Department of the University Hospital of Geneva alone produced more than 12,000 images a day in 2002. The cardiology is currently the second largest producer of digital images, especially with videos of cardiac catheterization ( approximately 1800 exams per year containing almost 2000 images each). The total amount of cardiologic image data produced in the Geneva University Hospital was around 1 TB in 2002. Endoscopic videos can equally produce enormous amounts of data. With digital imaging and communications in medicine (DICOM), a standard for image communication has been set and patient information can be stored with the actual image(s), although still a few problems prevail with respect to the standardization. In several articles, content-based access to medical images for supporting clinical decision-making has been proposed that would ease the management of clinical data and scenarios for the integration of content-based access methods into picture archiving and communication systems (PACS) have been created. This article gives an overview of available literature in the field of content-based access to medical image data and on the technologies used in the field. Section 1 gives an introduction into generic content-based image retrieval and the technologies used. Section 2 explains the propositions for the use of image retrieval in medical practice and the various approaches. Example systems and application areas are described. Section 3 describes the techniques used in the implemented systems, their datasets and evaluations. Section 4 identifies possible clinical benefits of image retrieval systems in clinical practice as well as in research and education. New research directions are being defined that can prove to be useful. This article also identifies explanations to some of the outlined problems in the field as it looks like many propositions for systems are made from the medical domain and research prototypes are developed in computer science departments using medical datasets. Still, there are very few systems that seem to be used in clinical practice. It needs to be stated as well that the goal is not, in general, to replace text-based retrieval methods as they exist at the moment but to complement them with visual search tools.

Databases, Factual↗