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PubMed2006

Technology-enhanced interactive surgical education.

BACKGROUND: Our goal was to create surgical resident centered, interactive teaching modules rich in basic science and clinical content directly pertinent to patient care and surgical techniques that would facilitate education in the 80-h work week environment. METHODS: A systematic evaluation of available instructional tools determined that a technology-enhanced approach can effectively and efficiently address the new requirements for resident learning. An extensive evaluation of available technology determined the technology best suited to teaching the adult surgical learner. RESULTS: An on-line, multimedia-based surgical education environment using WebCT Vista (WebCT, Inc., Lynnfield, MA) and Macromedia Breeze (Adobe Systems, Inc., San Jose, CA) software packages was implemented. The concept was constructed on tenets of adult learning theory and based on the APDS curriculum and ACGME core competencies. WebCT Vista serves as virtual scaffolding, and Macromedia Breeze functions to deliver content rich multimedia audio and visual presentations. Core subdiscipline teaching modules were created, comprised of individual lecture packets developed by faculty. Components for testing pre/post module knowledge, feedback and evaluations are built-in. The online nature allows for 24-h access at locations that are convenient to the resident. CONCLUSIONS: Teaching modules enable maximal trainee and instructor flexibility, which translates into optimal adult learning and teaching. Lecture packets can be conveyed to all residents with unlimited availability in the virtual domain. Further refinement and continued implementation will help fill the void in direct didactic teaching left by mandated work hour restrictions, allowing for more efficient learning and teaching. There is great potential for broad application of the concept and technology to other training programs.

Adult↗
PubMed2003

Intravenous catheter training system: computer-based education versus traditional learning methods.

BACKGROUND: Virtual reality simulators allow trainees to practice techniques without consequences, reduce potential risk associated with training, minimize animal use, and help to develop standards and optimize procedures. Current intravenous (IV) catheter placement training methods utilize plastic arms, however, the lack of variability can diminish the educational stimulus for the student. This study compares the effectiveness of an interactive, multimedia, virtual reality computer IV catheter simulator with a traditional laboratory experience of teaching IV venipuncture skills to both nursing and medical students. METHODS: A randomized, pretest-posttest experimental design was employed. A total of 163 participants, 70 baccalaureate nursing students and 93 third-year medical students beginning their fundamental skills training were recruited. The students ranged in age from 20 to 55 years (mean 25). Fifty-eight percent were female and 68% percent perceived themselves as having average computer skills (25% declaring excellence). The methods of IV catheter education compared included a traditional method of instruction involving a scripted self-study module which involved a 10-minute videotape, instructor demonstration, and hands-on-experience using plastic mannequin arms. The second method involved an interactive multimedia, commercially made computer catheter simulator program utilizing virtual reality (CathSim). RESULTS: The pretest scores were similar between the computer and the traditional laboratory group. There was a significant improvement in cognitive gains, student satisfaction, and documentation of the procedure with the traditional laboratory group compared with the computer catheter simulator group. Both groups were similar in their ability to demonstrate the skill correctly. CONCLUSIONS; This evaluation and assessment was an initial effort to assess new teaching methodologies related to intravenous catheter placement and their effects on student learning outcomes and behaviors. Technology alone is not a solution for stand alone IV catheter placement education. A traditional learning method was preferred by students. The combination of these two methods of education may further enhance the trainee's satisfaction and skill acquisition level.

Adult↗
PubMedDate not supplied

Comparison of preferences for health outcomes in schizophrenia among stakeholder groups.

BACKGROUND: To determine the effectiveness of psychiatric interventions for use in cost-effectiveness analysis, we assessed the feasibility of using a multimedia computer survey to study preferences (utilities) for health outcomes among persons with schizophrenia, family members of persons with schizophrenia, health professionals, and the public. METHODS: We developed videos depicting two patterns of mental health impairment in schizophrenia, both with and without pseudo-parkinsonism side-effects. These descriptions were integrated into a computer program that measured preferences using two psychometric methods: (1) standard gamble and (2) a visual analog scale. This program was used to compare preferences among potential stakeholder groups. RESULTS: 20 persons with schizophrenia, 11 family members, 20 healthy volunteers and 14 health professionals participated in the computerized interview. All but one subject completed the survey. The correlation among ratings of various states was high (r=0.7-0.95) and ratings were internally consistent in 89% of participants. There were significant differences in values between groups for health states (p=0.024) and in values for the effects of pseudo-parkinsonism on quality of life (p<0.001). Persons with schizophrenia valued the disease states more highly and placed more significance than did other groups on the effects of pseudo-parkinsonism on quality of life. CONCLUSIONS: Computer-based multimedia techniques can offer a feasible and valid approach to measure preferences for outcomes in schizophrenia. The study found significant differences in preferences among stakeholder groups for schizophrenia outcomes. Further work is needed to clarify how these differences affect clinical decision-making and policies for health resource allocation.

Adult↗
PubMed2001

Relationship of approaches and a tiered methodology for screening chemicals in the context of long-range transport.

In many national and international initiatives, where thousands of chemicals are screened, the ability of a chemical to be transported over long distances is an important criterion in determining whether environmental concern is warranted. Preliminary screening can be conducted using: (1) effective travel distance (ETD); (2) characteristic travel distance (CTD); and/or (3) the degradation half-life in air. The CTD is the distance traveled before the concentration of a chemical in air is reduced by a factor of 50%, for example. Differences in the distance traveled associated with the environmental release medium of a chemical are taken into account the ETD measure. The ETD can be defined as the distance traveled before the concentration in a stated medium (air, water, soil or sediment) is reduced to a specified level for a given mass release rate to air, to water and/or to soil. However, despite their merits, the use of multimedia screening measures like the ETD and CTD remains inhibited by both the limited availability of degradation data (particularly for soils and sediments) and release pattern information. Preliminary screening in terms of the atmospheric degradation half-life is commonly the only practical option. In this paper, straightforward guidelines based on partitioning coefficients (Henry's law constant and octanol water partitioning coefficient) are proposed to reduce the degradation data requirements of multimedia measures like the ETD and CTD. The values used in the guidelines reflect a quantifiable trade-off between data acquisition requirements and uncertainty. The relationship of the potential screening options (using all degradation data versus using only data identified as required in the CTD and ETD approaches; screening in terms of the degradation half-life in air versus the CTD versus the ETD) is derived and the consequences of the differences are illustrated. A three-tiered screening methodology is then proposed. This tiered methodology will result in significant savings in time and money in national and international screening initiatives.

Air Movements↗
PubMed2002

Using stochastic risk assessment in setting information priorities for managing dioxin impact from a municipal waste incinerator.

The objectives of this study were to assess site-specific carcinogenic risk of incinerator-emitted dioxins in a manner reflecting pollutant transfer across multimedia and multi-pathways. The study used site-specific environmental and exposure information and combined the Monte Carlo method with multimedia modeling to produce probability distributions of risk estimates. The risk estimates were further categorized by contaminated environmental media and exposure pathways that are experienced by human receptors in order to pinpoint significant sources of risk. Rank correlation coefficients were also calculated along with the Monte Carlo sampling to identify key factors that influenced estimation of risk. The results showed that ingestion accounted for more than 90% of the total risk and that risk control on ingestion of eggs, aboveground vegetables, and poultry should receive priority. It was also found that variation of parameters with variability accounted for around 35% of the total risk variance, while uncertainty contributed to the remaining 65%. Intake rates of aboveground vegetables, eggs, and poultry were the key parameters with the largest contribution to variance. In addition, sufficient sampling and analysis of dioxin contents in eggs, aboveground vegetables, poultry, soil, and fruit should be performed to improve risk estimation because the variation in concentrations in these media accounted for the largest overall risk variance. Finally, focus should be placed on reduction of uncertainty associated with the risk estimation through ingestion of aboveground vegetables, eggs, poultry, fruit, and soil because the risk estimates associated with these exposure pathways had the largest variance.

Animals↗
PubMed1999

Application of a computer based education system for aged persons and issues arising during the field test.

We plan to apply a computer-based multimedia text-book system for health education in the future. To do this, the computer system should be manageable to any person regardless of age or computer experience. We developed a multimedia text-book system and field-tested it to survey the reaction of aged persons. The system offers information about obesity prevention, such as a guide for eating and exercise. All contents are presented by text, image and voice. Also, a guide for exercise is shown by a movie. In this investigation we found that there were many considerations for aged persons using a computer. They seemed to have a strong aversion toward computers. They had the feeling that computers are difficult to use; actually 22 persons among 65 could not use it. Improvements in user interface seems to be the most important thing to make computers accessible to aged persons. On the other hand, question-and-answer programs for diagnosing one's health status were well accepted. Such a function is useful for attracting the interest of aged persons when we design a computer-based education system.

Aging↗
PubMed2001

The untapped potential of Telehealth.

The people of Malaysia generally enjoy a high standard of health. This is largely attributed to the comprehensive range of health services provided by the Government and the private sector at affordable costs. However, there are changing trends that now seriously challenge this status quo. The changing population structure, lifestyle, disease patterns and globalization are causing healthcare costs to rise. New and innovative ways will have to be devised to further improve the health status and at the same time contain costs. Information and Communication Technology (ICT) presents unprecedented opportunities to help the health sector in Malaysia reinvent itself and transform the way health and healthcare is managed and delivered in the future. Malaysia's Telehealth initiative under the Multimedia Super Corridor (MSC) project is designed to realize Malaysia's health vision and goals and meet future health challenges. Multimedia and Internet technology will be fully harnessed to deploy services that will shift the emphasis from episodic management of illness to proactive promotion of lifelong wellness and disease prevention. Health information content and interactive applications will engage the people to work as partners of health with healthcare professionals in maintaining their own health or managing their illnesses.

Delivery of Health Care, Integrated↗
PubMed2001

Review of telemedicine projects in Taiwan.

Taiwan is a heavily populated country, with a small land area and many mountains and isolated islands. Because medical resources are unequally distributed, high quality accessible medical care is a major problem in rural areas. Medical personnel are unwilling to practice in rural areas because of fear of isolation from peers and lack of continuing medical education (CME) in those areas. Telemedicine provides a timeless and spaceless measure for teleconsultation and education. The development of telemedicine in Taiwan began under the National Information Infrastructure (NII) Project. Distance education and teleconsultation were the first experimental projects during the initiation research stage. The cost and effectiveness of the hardware and network bandwidth were evaluated. In the promotion research stage, applications in different medical disciplines were tested to promote multipoint videoconference, electronic journals and VOD. Investigation of user satisfaction put on more emphasis on improving application functions. In 1998, a new Cyber Medical Center (CMC) international collaboration project was begun, integrating technologies of multimedia, networking, database management, and the World Wide Web. The aim of the CMC is to create a multimedia network system for the management of electronic patient records, teleconsultation, online continuing medical education, and information services on the web. A Taiwan mirror site of Virtual Hospital and two international telemedicine trials through Next Generation Internet (NGI) were done at the end of 1998. In the future, telemedicine systems in Taiwan are expected to combine the Internet and broadband CATV, ADSL, and DBS networking to connect clinics, hospitals, insurance organizations, and public health administrations; and, finally, to extend to every household.

Databases, Factual↗
PubMed2005

Assessing the influence of climate variability on atmospheric concentrations of polychlorinated biphenyls using a global-scale mass balance model (BETR-global).

We introduce a new global-scale multimedia contaminant fate model (the Berkeley-Trent Global Model; BETR-Global) that integrates global climate data from the National Centers for Environmental Prediction (NCEP). BETR-Global represents the global environment as a connected set of 288 multimedia regions on a 15 degrees grid. We evaluate the model by simulating the global fate and transport of seven PCB congeners over a 70 year period and find satisfactory agreement between model output and observations of atmospheric PCB concentrations at 11 long-term monitoring stations in the Northern Hemisphere. We demonstrate the use of the model as a tool for understanding global pollutant dynamics by examining the hypothesis that variability in global-scale climate conditions, as reflected bythe North Atlantic Oscillation (NAO), influences atmospheric PCB concentrations in the Northern Hemisphere. We estimate that the maximum variability in atmospheric PCB concentrations attributable to NAO variability is approximately a factor of 2. The influence of variability in the NAO on PCB concentrations in air is most likely to be observed in the winter and spring at monitoring sites in Northern Europe and the Arctic. Analysis of long-term monitoring data from 11 sites shows some statistically significant relationships between NAO indices and atmospheric PCB concentrations during the winter and spring. Giving consideration to competing factors that influence atmospheric PCB concentrations, longer time series of monitoring data are required to fully evaluate the modeling results and to improve our understanding of the role of climate variability on the long-term fate of persistent semivolatile pollutants.

Arctic Regions↗
PubMed2002

Spectral characteristics of light sources for S-cone stimulation.

PURPOSE: Electrophysiological investigations of the short-wavelength sensitive pathway of the human eye require the use of a suitable light source as a S-cone stimulator. Different light sources with their spectral distribution properties were investigated and compared with the ideal S-cone stimulator. METHODS: First, the theoretical background of the calculation of relative cone energy absorption from the spectral distribution function of the light source is summarized. From the results of the calculation, the photometric properties of the ideal S-cone stimulator will be derived. The calculation procedure was applied to virtual light sources (computer generated spectral distribution functions with different medium wavelengths and spectrum widths) and to real light sources (blue and green light emitting diodes, blue phosphor of CRT-monitor, multimedia projector, LCD monitor and notebook display). The calculated relative cone absorbencies are compared to the conditions of an ideal S-cone stimulator. RESULTS: Monochromatic light sources with wavelengths of less than 456 nm are close to the conditions of an ideal S-cone stimulator. Spectrum widths up to 21 nm do not affect the S-cone activation significantly (S-cone activation change < 0.2%). Blue light emitting diodes with peak wavelength at 448 nm and spectrum bandwidth of 25 nm are very useful for S-cone stimulation (S-cone activation approximately 95%). A suitable display for S-cone stimulation is the Trinitron computer monitor (S-cone activation approximately 87%). The multimedia projector has a S-cone activation up to 91%, but their spectral distribution properties depends on the selected intensity. LCD monitor and notebook displays have a lower S-cone activation (< or = 74%). CONCLUSION: Carefully selecting the blue light source for S-cone stimulation can reduce the unwanted L-and M-cone activation down to 4% for M-cones and 1.5% for L-cones.

Humans↗
PubMed2004

Quicktime virtual reality technology in light microscopy to support medical education in pathology.

The new computer-based interactive technologies in medicine, such as virtual reality (VR), have revolutionized education. The use of virtual microscopic images would be invaluable in the training of cyto-histopathologists. However, due to the vast amount of digital information on a scanned, conventional cyto-histological slide, which is enormous by current data storage standards, these systems are expensive and not widely used in pathological medicine. The authors propose an inexpensive system based on quicktime virtual reality (QTVR) technology (by Apple Computers Inc.), which accommodates a wide area of a slide at high magnification, generating a 'virtual slide' which makes it possible to navigate by conventional input devices. Commercial softwares that stitch consecutive, adjacent images of cyto-histological preparations onto a QTVR panorama were used. QTVR files have the ability to stand on their own as self-contained, multimedia applications and also have the ability to generate multinode scenes by means of 'hot spots'. QTVR 'movies' can be played on Macintosh or Windows platforms, and on major web browsers. Virtual slides by QTVR is an inexpensive system of high educational value, which allows the creation of multimedia databases of cyto-histological preparations that can exist on an internet server or can be distributed on removable media.

Databases as Topic↗
PubMed2004

Contribution of locally grown foods in cumulative exposure assessments.

Both laboratory and field studies confirm the importance of vegetation for scavenging semivolatile organic chemicals (SVOCs) from the atmosphere and a number of exposure studies have found that the dietary pathway is often a significant contributor to cumulative exposure for these chemicals. However, little information exists on the atmospheric source-to-dietary intake linkage for SVOCs. Because of higher SVOC emissions to urban regions, this linkage is particularly important for foods that are grown, distributed and consumed in or near urban regions. The food pathway can also contribute to dietary exposure for populations that are remote from a pollutant source if the pollutants can migrate to agricultural regions and subsequently to the agricultural commodities distributed to that population. We use available data, the characteristic travel distance, and the CalTOX multimedia model framework to assess the contribution of local sources of food to cumulative SVOC intake. Based on published concentration data for foods, our exposure calculations indicate that the potential intake through ingestion can be up to 1000 times that of inhalation for certain persistent SVOCs. We use the population-based intake fraction (iF) to determine how SVOC intake can vary among food commodities and exposure pathways, and to determine the contribution of airborne emitted SVOCs to the diet in the Northern Hemisphere. We focus on three representative multimedia SVOCs-benzo(a)pyrene, fluoranthene, and 2,3,7,8-tetrachlorodibenzo-p-dioxin. The approach presented here provides a useful framework and starting point for source-to-intake assessments for the ambient air-to-dietary exposure pathway.

California↗
PubMed2004

The effect of export to the deep sea on the long-range transport potential of persistent organic pollutants.

BACKGROUND: Export to the deep sea has been found to be a relevant pathway for highly hydrophobic chemicals. The objective of this study is to investigate the influence of this process on the potential for long-range transport (LRT) of such chemicals. METHODS: The spatial range as a measure of potential for LRT is calculated for seven PCB congeners with the multimedia fate and transport model ChemRange. Spatial ranges for cases with and without deep sea export are compared. RESULTS AND DISCUSSION: Export to the deep sea leads to increased transfer from the air to the surface ocean and, thereby, to lower spatial ranges for PCB congeners whose net deposition rate constant is similar to or greater than the atmospheric degradation rate constant. This is fulfilled for the PCB congeners 101, 153, 180, and 194. The spatial ranges of the congeners 8, 28, and 52, in contrast, are not affected by deep sea export. With export to the deep sea included in the model, the spatial ranges of the heavier congener are similar to those of the lighter ones, while the intermediate congeners 101 and 153 have the highest potential for long-range transport. CONCLUSIONS: Transfer to the deep ocean affects the mass balance and the potential for LRT of highly hydrophobic chemicals and should be included in multimedia fate models containing a compartment for ocean water.

Air Movements↗
PubMed2001

Simulation and new learning technologies.

Changes in medical practice that limit patient availability and instructors' time have resulted in poor physical diagnosis skills by learners at all levels. Advanced simulation technology, including the use of sophisticated multimedia computer systems, helps to address this problem. For many years 'Harvey', the Cardiology Patient Simulator, and the UMedic Multimedia Computer system have proven to be effective tools to teach and assess bedside cardiovascular skills when they are integrated into the required curriculum of medical school and postgraduate training. In the future, virtual reality technology, based initially on data from the Visible Human Data set, will provide the majority of simulation-based training. Models that provide a high level of visual fidelity and use sophisticated haptic devices that simulate the 'touch' and 'feel' of a procedure or examination are now being used in selected medical centers. The presence of these tools is not enough. Evidence-based outcomes must show these systems to be effective instruments for teaching and assessment, and medical educators must be willing to effect change in medical education to ensure the appropriate use of these systems in the next millennium.

Journal Article↗
PubMedDate not supplied

The virtual courtroom: a view of justice. Project to prepare witnesses or victims with learning disabilities to give evidence.

PURPOSE: With the advent of 'The Youth Justice and Criminal Evidence Act 1999' passed by Parliament in August 1999, vulnerable witnesses can for the first time give evidence to the court with the support of 'special measures'. People with a learning disability fall into the category of vulnerable witnesses, and the purpose of this paper is to describe the development of the virtual courtroom, a virtual reality (VR) and multimedia based training platform to prepare this group of people for such an eventuality. METHOD: A user-centred design methodology was adopted, with a user group being formed of students and adults with learning disabilities. This group, working together with facilitators, experts on the new act, and experienced designers of VR based training systems, designed and implemented the virtual courtroom. RESULTS: The virtual courtroom model has been produced using the Realimation Virtual Reality software tool. The next stage of the project is to design and develop three multimedia-based scenarios showing a variety of situations in which a person with a learning disability could give evidence in court. CONCLUSION: One of the recommendations in the 'Speaking up for justice' report, suggested that the Home Office develop further material to assist vulnerable witnesses to prepare for their attendance at court. The virtual courtroom provides one of the first and most innovative of such solutions.

Adolescent↗
PubMedDate not supplied

Impact of the integrated Radio Communication Project in Nepal, 1994-1997.

The Radio Communication Project (RCP) in Nepal is an ongoing, theory-based, multimedia reproductive health campaign which began in 1995. It consists of two entertainment-education radio serials (a soap opera for the general public and a dramatized distance education serial for health workers), additional radio spot advertisements and promotions, and complementary print materials. This paper examines impact data from a variety of sources, including a pre- and postpanel survey of currently married women (N = 1905), three waves of clinic-based observations of client-provider interactions (N = 240 per wave) and client exit interviews (N = 240 per wave), and 2 years of clinic service statistics, in order to draw inferences about the separate and combined effects of the RCP components. The study found increased health worker interpersonal interaction skills, improved quality of client-provider interactions, increased client self-efficacy in dealing with health workers, improved client attitudes toward health services and toward the practice of family planning, increased adoption of family planning, and increased family planning service utilization, all attributable to the RCP. The panel data allowed statistical control of the influence of predisposing factors before the campaign on postcampaign ideation and behavior. The effect of the RCP on contraceptive behavior was largely indirect through its influence on ideation. Implications for the design of integrated, multimedia, entertainment-education campaigns and integrated evaluation designs are discussed.

Female↗
PubMed2002

Internet and continuing medical education.

Keeping abreast of medical advances is an important, ongoing responsibility for medical professionals, one that categorises physicians as lifelong students. In the USA, continuing medical education (CME) is the bridge that connects basic research and the practicing physician, who must fulfill credit requirements for licensure and board certification. Developments in multimedia technology and the Internet have made online CME courses possible, making the process of obtaining CME credits more efficient and convenient for physicians. Although first-generation courses have been criticised for the lack of interactivity, new developments in multimedia technologies and broadband connectivity promise a new online learning experience, where distant participants can communicate using voice or video channels. In addition, future online CME generations may incorporate virtual reality modules that will enable physicians to learn and practice procedural techniques, as well as gain knowledge. Continued application of sophisticated technologies and continued content-development promises to add new dimensions to traditional learning and may identify online CME courses as a major medical education paradigm.

Journal Article↗
PubMed2003

From data to knowledge in e-health applications: an integrated system for medical information modelling and retrieval.

The system described in this paper uses the technological advances in information technology in order to influence and improve healthcare practice by enabling the flexible modelling, direct representation and adaptable use of medical knowledge. It aims at resolving a number of difficulties encountered by current information repositories, such as costly customization, reusability, high maintenance and poor information modelling, by employing the architecture of the functional data model (FDM), while maintaining full interoperability with existing systems by means of XML. On the information-modelling front the system supports a variety of modelling techniques that are especially relevant to medical applications, such as complex objects, incomplete or missing information, partially structured data and multimedia content. A prototype implementation of the system has been developed which consists of a multimedia-enhanced version of the functional database language FDL, and a web-based, two-way translator interface between the application's native language and XML. This interface provides full interoperability with other, heterogeneous systems over the web, thus, significantly reducing the complexity of developing distributed healthcare systems and e-health applications.

Computer Communication Networks↗