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Recent advances in telemedicine.

With continuing advances in information technology, the applications of computers in medicine are increasing rapidly. Modern information technology not only affects the delivery of health care, but also significantly influences the doctor-patient relationship. Since the 1990s, technologic developments in high-bandwidth telecommunications systems and digitizing devices have led to a surge of interest in telemedicine. In recent years, the Internet, with its powerful penetration and scalability, has become an increasingly popular medical information resource and a new platform for telemedicine. The impact of modern technology on the advancement of telemedicine in Taiwan started with the 1995 National Information Infrastructure project, which uses networks of different bandwidths for teleconsultation and distance education programs. In 1998, National Taiwan University and Taipei Medical College in Taiwan, and the University of Pittsburgh and the University of Iowa in the USA, began cooperation on a new Cyber Medical Center (CMC) project that integrates the technologies of multimedia, database management, a multiple-site videoconferencing system, 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. In the future, telemedicine systems in Taiwan are expected to combine the Internet and cable television to connect clinics, hospitals, insurance organizations, and public health administrations; and, finally, to extend health services to every household.

Humans↗

Development and test of a model for designing interactive CD-ROMs for teaching nursing skills.

The use of interactive multimedia is well documented in the education literature as a medium for learning. Many schools of nursing and healthcare agencies purchase commercially-made CD-ROM products, and, in other cases, educators develop their own. Since nurses are increasingly designing CD-ROMs, they must be aware of the instructional design needed to develop comprehensive and effective CD-ROMs that do not compromise the quality of education. This article describes a process for developing and testing an interactive, multimedia CD-ROM on oral medication administration, using an instructional design model based on Chickering and Gamson's Principles of Good Practices in Education. Results from testing the model are reported. The findings can be used to guide the work of nurse educators who are interested in developing educational software.

Audiovisual Aids↗

[The importance of Internet in medical education].

Internet is more and more involved in medical education in many countries including Bosnia and Herzegovina. Not only medical student but also physicians are using Internet to find out the latest information in specific field of medicine. Some sites are specially designed to be used for medical education. Information about some programs or courses of medical education can be found here. Improvements of network resources and multimedia technologies have made it possible to satisfy needs for medical Education. Multimedia approach offer possibility to show text, picture, sound or movie considering specific need. All of that is available on Internet. Many search engine are available in the world and student can use all of them when they have access to Internet. The more precise search can be done on specific sites that include information about medical conditions and medical education. The most important is MEDLINE. MEDLINE is bibliographic database of National Library Of Medicine in USA. This database can be explored from several sites. All relevant information about article can be find here including abstract and service to obtain full text of specific article. Database can be searched using specific keywords that can be find in text or in MESH thesaurus. Data about authors, their addresses and title of article can be found, too. The possibility of using Internet in medical education are considered in this article. Some of Internet sites are described, too.

Education, Medical↗

Applications of computer-aided learning in biomedical sciences: considerations in design and evaluation.

Multimedia computer-aided learning (CAL) is an area that has become increasingly prevalent in biomedical science. Here we describe the advances that have taken place in the computing industry that have led to this trend. We also outline areas within the subject of biomedical science that can most benefit from using multimedia CAL as a teaching aid. Furthermore, issues concerning the design of CAL (i.e. iterative design, structure, development tools) are discussed. As the evaluation of CAL is an essential part of the iterative design process, we look at new approaches to evaluation that have emerged in response to the superficial focus on usability that many evaluations take.

Computer-Assisted Instruction↗

Virtual university applied to telesurgery: from teleeducation to telemanipulation.

UNLABELLED: PROBLEM/BACKGROUND: In order to improve patient care by minimal invasive surgery (MIS), we perfected a Virtual TeleSurgical University that allows for teleeducation, teleconcertation, surgical planning and telemanipulation, through new Virtual Reality and multimedia systems. TOOLS AND METHODS: The organization of this innovative school was federated around three major research programs. First, the TESUS program focused on the teletransmission of medical information, allowing for videoconferencing around the world and telementoring. Next, the WeBS-Surg program is a multimedia continuous surgical education system on internet, that allows for teleeducation and teleconcertation between world experts in MIS. Then, the MASTER program (Minimal Access Surgery by Telecommunications and Robotics) allowed the development of the third millenium Operating room. It included Virtual Reality systems that delineate automatically anatomical and pathological structures of a patients from him CT-scan, and that allow for an interactive surgical planning and force-feed-back simulation. It also included a telesurgical robot named Zeus controlled by surgeons through telemanipulation system. RESULTS: Tests and validation shows that all these systems improved all steps of the surgical procedure: preoperatively due to a better continuous education and a computer assisted surgical planning, and peroperatively due to teleconcertation, telementoring and telemanipulation systems. CONCLUSION: Revolutionary tools for minimal invasive surgery learning, planning and performing are all ready available. These tools represents the first prototype of the computer assisted tele-robotical surgery that will be the future of surgery.

Computer Simulation↗

Graphical tool for navigation within the semantic network of the UMLS metathesaurus on a locally installed database.

Knowledge in the environment of information technologies is bound to structured vocabularies. Medical data dictionaries are necessary for uniquely describing findings like diagnoses, procedures or functions. Therefore we decided to locally install a version of the Unified Medical Language System (UMLS) of the U.S. National Library of Medicine as a repository for defining entries of a medical multimedia database. Because of the requirement to extend the vocabulary in concepts and relations between existing concepts a graphical tool for appending new items to the database has been developed: Although the database is an instance of a semantic network the focus on single entries offers the opportunity of reducing the net to a tree within this detail. Based on the graph theorem, there are definitions of nodes of concepts and nodes of knowledge. The UMLS additionally offers the specification of sub-relations, which can be represented, too. Using this view it is possible to manage these 1:n-Relations in a simple tree view. On this background an explorer like graphical user interface has been realised to add new concepts and define new relationships between those and existing entries for adapting the UMLS for specific purposes such as describing medical multimedia objects.

Computer Graphics↗

Liquid chromatography/electrospray ionization/isotopic dilution mass spectrometry analysis of n-(phosphonomethyl) glycine and mass spectrometry analysis of aminomethyl phosphonic acid in environmental water and vegetation matrixes.

A liquid chromatography/electrospray/mass spectrometry (LC/ES/MS) method was developed for the analysis of glyphosate (n-phosphonomethyl glycine) and its metabolite, aminomethyl phosphonic acid (AMPA) using isotope-labelled glyphosate as a method surrogate. Optimized parameters were achieved to derivatize glyphosate and AMPA using 9-fluorenylmethyl chloroformate (FMOC-Cl) in borate buffer prior to a reversed-phase LC analysis. Method spike recovery data obtained using laboratory and real world sample matrixes indicated an excellent correlation between the recovery of the native and isotope-labelled glyphosate. Hence, the first performance-based, isotope dilution MS method with superior precision, accuracy, and data quality was developed for the analysis of glyphosate. There was, however, no observable correlation between the isotope-labelled glyphosate and AMPA. Thus, the use of this procedure for the accurate analysis of AMPA was not supported. Method detection limits established using standard U.S. Environmental Protection Agency protocol were 0.06 and 0.30 microg/L, respectively, for glyphosate and AMPA in water matrixes and 0.11 and 0.53 microg/g, respectively, in vegetation matrixes. Problems, solutions, and the method performance data related to the analysis of chlorine-treated drinking water samples are discussed. Applying this method to other environmental matrixes, e.g., soil, with minimum modifications is possible, assuring accurate, multimedia studies of glyphosate concentration in the environment and the delivery of useful multimedia information for regulatory applications.

Chromatography, Liquid↗

OphthWeb---cost-effective telemedicine for ophthalmology.

'OphthWeb' is an ophthalmic electronic medical record that can be accessed locally and globally via the Internet. OphthWeb can provide secure multimedia patient data to doctors, patients, and health care providers at any time and in any place. Patients have secured access to their own records in the convenience of their homes or during any emergency at any time or place around the world. OphthWeb provides interactive educational information and answers frequently asked questions by way of multimedia images on the Worldwide Web. A data transmission trial was conducted between the Xiamen Eye Centre in the Fujian province in southern China and Singapore. Clinical records, voice messages, and fundus and slit-lamp images were transmitted from Xiamen, and an off-line dialogue by e-mail and Internet-relay chat was conducted. The time delay from transmission to receipt was 30 minutes, which would be adequate to respond to most ophthalmic emergencies. This pilot project will promote computer literacy among doctors, and inter-institutional interaction in the health care profession. OphthWeb can provide telemedicine and electronic medical records at a low cost and great convenience.

Journal Article↗

Development of a Web-based question database for students' self-assessment.

OBJECTIVE: Computer-based testing (CBT) for the purpose of the national licensure examination has increased interest among medical students in this modality of testing. The advent of Web-based question-delivery systems for self-assessment and learning has made it possible for students to practice this technology and participate in self-directed learning. Test Pilot(TM) is a Web-based program that provides a fast and easy tool for the development and deployment of online testing. Our objectives for introducing the program were to (1) develop a large database of questions for students' practice and self-assessment; (2) include multimedia tools such as illustrations and short videos to enhance learning; (3) provide a feedback tool for clerkship and site directors regarding student performance; and (4) evaluate this tool in terms of students' frequency of use, students' satisfaction, and its potential effectiveness in enhancing learning. DESCRIPTION: The Obstetrics and Gynecology clerkship at the University of Michigan is held at four different sites. In the past, students have been provided with access to floppy disks that contain about 500 self-assessment questions. These questions have been reformatted, updated, and transferred to Test Pilot. Visual illustrations have been added to the questions along with more varied formats, including extended matching, fill-in, and essay questions. The questions are divided into ten-question quizzes. The students get immediate feedback after answering each question and a summary of performance at the end of each quiz. Security, access, and analysis are facilitated because the questions and responses are stored centrally. In addition, Test Pilot captures information regarding individual and collective students' performances. At the end of the rotation, students fill out a form evaluating the Test Pilot program and comparing it with the quiz disks. In addition, we are collecting data regarding the actual use of Test Pilot, which will be compared with the students' surveys and final exam scores. DISCUSSION: Test Pilot has many benefits, including access control, immediate feedback, automated scoring, interactive learning, and data analysis. The enhancement of material permitted by a Web-based system increases the depth and variety of the learning experience by adding perceptual dimensions. Test Pilot also provides the clerkship director with the capability to obtain improved measurements of student performance and captures the student's self-learning and testing process. It can potentially identify weaknesses or inconsistencies across the different sites and recognize students who may need additional help early in the rotation. Over a one-year period, most students have switched from the quiz disks to Test Pilot. The students reported satisfaction with the Web-based format and found it user friendly. They especially liked the immediate feedback. The students have requested more questions and multimedia options be added. We plan to continue the development and assessment of this learning tool.

Databases, Factual↗

Pesticide risk assessment in a lagoon ecosystem. Part I: exposure assessment.

This work is the first step of a research project on pesticide risk assessment for a coastal lagoon ecosystem (Orbetello lagoon, central Italy). Pesticide exposure was evaluated by means of predictive and experimental approaches. Predicted environmental concentrations (PECs) for water and sediments were estimated using fugacity-based multimedia models. Pesticide loads were quantified through a study of the use to which agricultural land was put in the study area. Multimedia fate models were used to predict the environmental concentration of 29 active ingredients (mainly insecticides and herbicides) selected among the most widely used within the catchment basin. Worst-case environmental scenarios were developed for the application of these models, in agreement with the precautionary principle. Experimental monitoring was performed on 10 selected chemicals. To assess the value and limitations of predictive and experimental approaches, calculated PECs and monitoring results were compared and discussed. Combined modeling and monitoring approaches have been found to be the best way to date to assess proper exposure.

Ecosystem↗

Virtual reality and 3D visualizations in heart surgery education.

BACKGROUND: Computer assisted teaching plays an increasing role in surgical education. The presented paper describes the development of virtual reality (VR) and 3D visualizations for educational purposes concerning aortocoronary bypass grafting and their prototypical implementation into a database-driven and internet-based educational system in heart surgery. MATERIALS AND METHODS: A multimedia storyboard has been written and digital video has been encoded. Understanding of these videos was not always satisfying; therefore, additional 3D and VR visualizations have been modelled as VRML, QuickTime, QuickTime Virtual Reality and MPEG-1 applications. An authoring process in terms of integration and orchestration of different multimedia components to educational units has been started. RESULTS: A virtual model of the heart has been designed. It is highly interactive and the user is able to rotate it, move it, zoom in for details or even fly through. It can be explored during the cardiac cycle and a transparency mode demonstrates coronary arteries, movement of the heart valves, and simultaneous blood-flow. Myocardial ischemia and the effect of an IMA-Graft on myocardial perfusion is simulated. Coronary artery stenoses and bypass-grafts can be interactively added. 3D models of anastomotique techniques and closed thrombendarterectomy have been developed. Different visualizations have been prototypically implemented into a teaching application about operative techniques. CONCLUSIONS: Interactive virtual reality and 3D teaching applications can be used and distributed via the World Wide Web and have the power to describe surgical anatomy and principles of surgical techniques, where temporal and spatial events play an important role, in a way superior to traditional teaching methods.

Computer Simulation↗

Technology-based vs. traditional instruction. A comparison of two methods for teaching the skill of performing a 12-lead ECG.

The purpose of this study was to compare the effectiveness of an interactive, multimedia CD-ROM with traditional methods of teaching the skill of performing a 12-lead ECG. A randomized pre/posttest experimental design was used. Seventy-seven baccalaureate nursing students in a required, senior-level critical-care course at a large midwestern university were recruited for the study. Two teaching methods were compared. The traditional method included a self-study module, a brief lecture and demonstration by an instructor, and hands-on experience using a plastic manikin and a real 12-lead ECG machine in the learning laboratory. The second method covered the same content using an interactive, multimedia CD-ROM embedded with virtual reality and supplemented with a self-study module. There were no significant (p < .05) baseline differences in pretest scores between the two groups and no significant differences by group in cognitive gains, student satisfaction with their learning method, or perception of self-efficacy in performing the skill. Overall results indicated that both groups were satisfied with their instructional method and were similar in their ability to demonstrate the skill correctly on a live, simulated patient. This evaluation study is a beginning step to assess new and potentially more cost-effective teaching methods and their effects on student learning outcomes and behaviors, including the transfer of skill acquisition via a computer simulation to a real patient.

Adult↗

Integrating content-based visual access methods into a medical case database.

In the computer vision domain, content-based access methods to all forms of multimedia data are a hot research topic. A large number of tools have been developed to find documents in multimedia repositories and to manage the (visual) information that has been created, for example by the Internet. Although no general breakthrough has been achieved with respect to searching diverse databases with automatically extracted features, the techniques have gained acceptance in a few well-defined domains such as image agencies (Corbis) and trademark research. In the medical domain, the number of digital images produced and used for teaching, diagnostics and therapy is rising in a similar way as in other domains. Still, there are only a few image retrieval systems that use automatically extracted visual features for content-based access to medical image databases. This article describes the use of an open source image retrieval system (GIFT) that has been adapted for the use with medical images using the image case database CasImage that has been developed and maintained by the University Hospital of Geneva and that is in routine use. The first results show the potential of this technique to retrieve similar cases from a case database. This is an important task for teaching and might also become important for diagnostics using case-based reasoning, for example. For the use as a diagnostic tool, it is foreseen to specialize the visual features for the domain of lung image retrieval, using high resolution computed tomography (HRCT) images.

Database Management Systems↗

[Distance learning in postgraduate training of professionals. Example of occupational medicine specialization].

The rapid development of science, technology, economy and the society has one along with the wide recognition of lifelong education and learning society concepts. Scientific centres worldwide conduct research how the access to the information and multimedia technology could bring about positive changes in our lives including improvement in education and the learning environment. Mankind development in conformity with social progress and sustainable development faces a new educational concept of learning society and open education in the information age, supported with multimedia and data processing technology. Constrains in resources availability for broadening the access to education had led to search for alternative, more time and cost-effective systems of education. One of them is distance learning, applied with success in many countries. The benefits of distance learning are well proven and can be extended to occupational medicine. Major advantages include: the integration of studies with work experience, flexibility, allowing studies to be matched to work requirements, perceived work and leisure timing, continuity of career progression. Likewise is in Poland this form of education becomes more and more popular. The distance education systems have been seen as an investment in human resource development. The vast variety of courses and educational stages makes possible the modern method of knowledge to be easily accessible. Experience of the School of Public Health in Łódź in distance learning had shown remarkable benefits of the method with comparable quality of intramural and distance learning in respect of the knowledge and experience gained by students.

Clinical Competence↗

Telebaby videostreaming of newborns over Internet.

New information technologies are used to fill gaps in our need for communication. Hospitals are now starting to discover the possibilities of multimedia communication for their patients. Telebaby is a project of the University Medical Centre Utrecht that allows parents to view their newborn on the intensive care, high care or medium care unit at home. Standard Internet technology for distributing multimedia allows parents to virtually "visit" their baby more often and give parents the feeling of control. A non-complex technical system like Telebaby is easily adopted by the parents, implementing it in a closed environment like a hospital is the real challenge.

Academic Medical Centers↗

Evaluation of the benefit of VR simulation in a multi-media web-based educational tool.

WebSET is an Internet based educational tool that can be used on any standard personal computer. It has been developed by a European collaboration and integrates high quality multimedia learning materials with VR simulation. The aim of this study was to evaluate the benefit of the VR simulation on the learning of procedure based psychomotor skills. Subjects were divided into three groups. The group that used the entire package including the VR simulation were superior to the group that used only the multimedia component in terms of the their procedural skills in the post-training assessment. Both groups performed better than the controls.

Computer-Assisted Instruction↗

Stress management using UMTS cellular phones: a controlled trial.

One of the best strategies for dealing with stress is learning how to relax. However, relaxing is difficult to achieve in typical real world situations. For this study, we developed a specific protocol based on mobile narratives - multimedia narratives experienced on UMTS/3G phones - to help workers in reducing commuting stress. In a controlled trial 33 commuters were randomly divided between three conditions: Mobile narratives (MN); New age music and videos (NA); no treatment (CT). In two consecutive days the MN and NA samples experienced during their commute trip 2 x 2 6-minute multimedia experiences on a Motorola A925 3G phone provided by the "TRE" Italian UMTS carrier: the MN sample experienced a mobile narrative based on the exploration of a desert beach; the NA sample experienced a commercial new age video with similar visual contents. The trials showed the efficacy of mobile narratives in reducing the level of stress experienced during a commute trip. No effects were found in the other groups. These results suggest that 3G mobile handsets may be used as relaxation tool if backed by a specific therapeutic protocol and meaningful narratives.

Adult↗

Teaching nurses to provide patient centered evidence-based care through the use of informatics tools that promote safety, quality and effective clinical decisions.

Schools of Nursing face the challenge of providing students with experiences to use evidence-based consumer centric care information tools. To facilitate this challenge, a unique partnership was forged between a school of nursing and a leading clinical information systems corporation. This strategic partnership was created to advance the field of nursing informatics through the sharing of intellectual capital. Through this sharing, the goal is to study how technology can promote patient safety, support evidence-based care and facilitate consumer involvement in health care decisions. This paper describes the design, development and testing of a multimedia product that can be used by schools of nursing. This product can be integrated into a nursing curriculum to promote the use of informatics tools as an integral practice component. The multimedia product embraces the core competencies advocated by the Institute of Medicine's Health Professions Education Report.

Cooperative Behavior↗