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[Teleconference and telesurgery].

Interchange of information has become possible independent of the user's place or time by modern telemedical services and opens up new dimensions for diagnostic and therapeutic procedures. For teleconferences and teleconsultations in surgery, the intraoperative high-quality transmission of live images is essential without disturbing the sterility and operation routine. The clinical specifications require special systems for broadband, stereoscopic online image transmission both intra- and inter-institutionally. Moreover, a telemedical concept integrates the communication equipment suitable for the different diagnostic and functional facilities of a clinic, a digital multimedia patient record and modules for cooperative working. These implementations are a prerequisite for extensive telesurgical interventions using navigational tools, guided instruments or autonomous roboter systems. The realization of such a comprehensive telesurgical concept (OP 2000) is presented.

Computer Communication Networks↗

[Teleteaching in otorhinolaryngology. Part 2: the European database "medicstream"].

Searching the medical literature is mainly characterized by the use of databases. The time for reviewing and printing a paper causes a delay between the first presentation of scientific results in a lecture and the appearance of the appropriate journal publication. Moreover, the possibilities for the integration of multimedia data are limited. Because of the development of new compression algorithms for audiovisual digitization software, the near simultaneous transmission of scientific presentations, both visually and aurally, has been possible since 1999. The section telemedicine of the interdisciplinary study group on image guided surgical navigation from the University of Leipzig has developed "medicstream" as a unique, audiovisual, scientific internetdatabase. It allows the documentation of presentations at congresses and courses, including the discussion,over a freely accessible, widely available homepage, using a home developed streaming technology. All presentations are examined by an authorized editorial committee consisting of representatives with different medical specializations for content before the admission to the data base. A total of 392 presentations from seven scientific meetings can be selected by an integrated search machine and viewed with Windows Media Player or Real Player using a conventional or faster internet connection to the homepage www.medicstream.de. The quality of the audiovisual transmission depends on the receiver-lateral data transmission rate,whereby the minimum variant of 56 kB/s is characterized by good detectability of the contents. In an analysis period of 242 days,we registered 44,199 accesses and 4,488 attendances. The telemedicine data base "medicstream" can optimize quality and extend medical education by live-streaming as well as by archiving scientific presentations as audiovisual data.

Congresses as Topic↗

[Digital photography and video archives in ENT].

Digital media have become standard documentation tools in modern ENT clinics. To date, multiple formats are generated by variable data sources. Old fashioned archiving techniques with numerous print-outs, hard copies or even slides would soon generate an unmanageable data flood and require costly manpower for proper and precise maintenance. It has become obvious that data archiving is the prime challenge for modern hospital information technology. Multiple computerized multimedia archives exist and offer promising solutions for collecting and managing these data. From a clinical point of view, not only data centralisation but also interactions with existing network components and hospital information technology systems have to be made available. Here, we describe variable data sources and formats, centralisation techniques, networking options and discuss available digital documentation solutions.

Computer Communication Networks↗

[Evaluation of the Internet presence of diagnostic radiology units at German universities].

PURPOSE: Analyzing the availability and the contents of the internet homepages of the radiological departments of German universities. MATERIAL AND METHOD: In June and July 2001 the internet homepages of 36 radiological departments of German universities were evaluated in a study. A medical student experienced in using the world wide web examined the websites concerning the following criteria: research, teaching, informations for patients, clinical topics and general information. Additionally an evaluation of the technical standard of the presentation was performed. RESULTS: 31 of the 36 radiological departments presented a homepage in the world wide web. The subject research was presented by 29 institutes. Also 29 departments provided information concerning teaching in their presentations. In 24 cases informations especially for patients were given. In all topics there is a huge variety of the quality and quantity of the provided information throughout the different institutions. 21 homepages available without restriction during the study period; 3 were nearly completely under construction. Multimedia techniques were only used in 2 homepages. The structural hierarchy of the webpages was in the average only two or three levels. Only 6 providers presented an additional version of their homepage in english. CONCLUSION: In the moment the possibility of internet-presentation is sub-optimal used by the responsible persons of the radiological institutions. The main emphasis is on research and teaching. There is nearly no use of multimedial elements in the presentations. Only a minority of the homepages can be read by international viewers because of the lack of an english version of the pages.

Germany↗

Telementoring and teleproctoring.

Telemedicine has previously been defined as "live two-way interactive video communication between a physician and a patient and/or another physician, where all participants are able to see and hear one another much like a face to face encounter." This concept has gained recent notoriety because of the great advances in telecommunications and the potential future increased cost-effectiveness associated with its utilization. We have developed a telementoring deployment protocol that can be effectively used to introduce a student to telementoring processes. The strict protocol uses military commands to facilitate smooth information transfer. The use of a concept called tactical information deployment provides the surgeon with rapid access to reference information in the operating suite. Multimedia interactive CD-ROMs, with digitized movie clips, illustrations, sound bits, and the latest academic review of the literature arm the surgeon with a database that establishes an unprecedented clinical adaptive capability (CAC). The availability of this information is invaluable to surgeons in their initial advanced laparoscopic procedural efforts. Telementoring simulator opportunities are included to acclimate the participant to the process. If the process seems comprehensive, it is meant to be. This is a high-risk situation, and a patient's welfare is on the line. If this concept is to reach its maximal healthcare delivery potential, responsible and academically credible training programs should be established with directional guidelines.

Computer-Assisted Instruction↗

An overview of videostreaming on the Internet and its application to surgical education.

The Information Age has endowed mankind with a wealth of new technologies. Applications of these technologies are being developed to facilitate content exchange between individuals and institutions. Internet streaming is an exciting new technology that allows multimedia content to be stored and sent over the Internet, and medical educators are challenged to harness the potential of streaming for educational enhancement. This article helps to define streaming, examining its potential for surgical education.

Computer-Assisted Instruction↗

Informational landscapes in art, science, and evolution.

An informational landscape refers to an array of information related to a particular theme or function. The Internet is an example of an informational landscape designed by humans for purposes of communication. Once it exists, however, any informational landscape may be exploited to serve a new purpose. Listening Post is the name of a dynamic multimedia work of art that exploits the informational landscape of the Internet to produce a visual and auditory environment. Here, I use Listening Post as a prototypic example for considering the creative role of informational landscapes in the processes that beget evolution and science.

Art↗

Squire's Quest: intervention changes occurred at lunch and snack meals.

This study identified fruit, 100% juice and vegetables (FJV) consumption changes by meal among fourth grade students participating in Squire's Quest!, a 10-session individually focused psychoeducational multimedia game with many meal/environment specific behavioral change techniques incorporated into the programming. Participants in 26 elementary schools were randomly assigned to treatment or control groups. Four days of dietary intake were assessed before and after the intervention to determine FJV servings consumed by meal. Overall, students receiving the intervention consumed 1.0 serving FJV more per day compared with control condition students. Using mixed model analysis of covariance, significant increases were found for servings of fruit and 100% fruit juice at snacks, and regular vegetables at lunch for intervention school children compared with children in control condition schools. These meals and snacks were targeted by the intervention activities and appear to represent eating occasions for which the children might have had more control. Interventions need to incorporate new procedures to more directly target intake at breakfast and dinner.

Beverages↗

The Malaysian Telehealth Flagship Application: a national approach to health data protection and utilisation and consumer rights.

Telehealth refers to the integration of information, telecommunication, human-machine interface technologies and health technologies to deliver health care, to promote the heath status of the people and to create health. The Malaysian Telehealth Application will, on completion, provide every resident of the country an electronic Lifetime Health Record (LHR) and Lifetime Health Plan (LHP). He or she will also hold a smart card that will contain a subset of the data in the Lifetime Health Record. These will be the means by which Malaysians will receive "seamless continuous quality care" across a range of health facilities and health care providers, and by which Malaysia's health goal of a nation of "healthy individuals, families and communities" is achieved. The challenges to security and privacy in providing access to an electronic Lifetime Health Record at private and government health facilities and to the electronic Lifetime Health Plan at homes of consumers require not only technical mechanisms but also national policies and practices addressing threats while facilitating access to health data during health encounters in different care settings. Organisational policies establish the goals that technical mechanisms serve. They should outline appropriate uses and access to information, create mechanisms for preventing and detecting violations, and set sanctions for violations. Some interesting innovations have been used to address these issues against the background of the launching of the multimedia supercorridor (MSC) in Malaysia.

Computer Security↗

VISION2003: virtual learning units for medical training and education.

The project VISION2003 consists of several partners with different professions ranging from medicine to medical informatics, from computer science to didactics. Its aim is the development, testing, introduction and a long-time maintenance of an open, web-based, intelligent and adaptive teaching and learning system for medical education. The system is expected to enhance the acceptance and efficiency of conventional ways of learning by supplementing and supporting them and creating new methods for imparting knowledge ["VISION2003, Lehr-und Lernsysteme in der Medizin: Intelligente und Multimediale, Internetbasierte adaptive und intelligente Autorensysteme für kooperatives Training in der Medizin", (last valid on 17 January 2003) and Ein offenes sprachkonzept für verteilte wissensverarbeitung in der medizin, Tagungsabstract XVI International Congress of the European Federation for Medical Informatics MIE, September 2000]. This is done exemplarily in the specific fields of oncology, accident-surgery and cardiology in consideration of actual standards and didactical measures. The range of possible applications is wide, from electronically accessible scripts through example cases to complex simulations. The main focus of the project is the creation of an open and flexible internet platform for delivering multimedia-based learning units and the development of adaptive and intelligent authoring systems.

Computer-Assisted Instruction↗

WWW-based access to object-oriented clinical databases: the KHOSPAD project.

KHOSPAD is a project aiming at improving the quality of the process of patient care concerning general practitioner-patient-hospital relationships, using current information and networking technologies. The studied application field is a cardiology division, with hemodynamic laboratory and the population of PTCA patients. Data related to PTCA patients are managed by ARCADIA, an object-oriented database management system developed for the considered clinical setting. We defined a remotely accessible view of ARCADIA medical record, suitable for general practitioners (GPs) caring patients after PTCA, during the follow-up period. Using a PC, a modem and Internet, an authorized GP can consult remotely the medical records of his PTCA patients. Main features of the application are related to the management and display of complex data, specifically characterized by multimedia and temporal features, based on an object-oriented temporal data model.

Angioplasty, Balloon, Coronary↗

Trends in medical information retrieval on Internet.

Information on the World Wide Web is unstructured, distributed, multimedia and multilingual. Many tools have been developed to help users search for useful information: subject hierarchies, general search engines, browsers and search assistants. Although helpful, they present serious limitations, mainly in terms of precision, multilingual indexing and distribution. In this paper, we cover some on-line solutions to medical information discovery and present our own approach, the MARVIN (multi-agent retrieval vagabond on information network) project, which tackles medical information research with specialized cooperative retrieval agents. We also draw some outlines for future extensions.

Computer Systems↗

Visually enhanced CCTV digital surveillance utilizing Intranet and Internet.

This paper describes a solution for integrated plant supervision utilizing closed circuit television (CCTV) digital surveillance. Three basic requirements are first addressed as the platform of the system, with discussion on the suitable video compression. The system configuration is described in blocks. The system provides surveillance functionality: real-time monitoring, and process analysis functionality: a troubleshooting tool. This paper describes the formulation of practical performance design for determining various encoder parameters. It also introduces image processing techniques for enhancing the original CCTV digital image to lessen the burden on operators. Some screenshots are listed for the surveillance functionality. For the process analysis, an image searching filter supported by image processing techniques is explained with screenshots. Multimedia surveillance, which is the merger with process data surveillance, or the SCADA system, is also explained.

Equipment Design↗

Database of patients' experiences (DIPEx): a multi-media approach to sharing experiences and information.

The Database of Individual Patients' Experience of illness (DIPEx) is a multimedia website and CD-ROM that links patients' experiences with evidence-based information about treatments and the illness itself and with a range of other resources that may be useful, including support groups and links to other websites. DIPEx aims to identify the questions that matter to people when they are ill and it has potential for informing patients, educating healthcare professionals, and providing a patient-centred perspective to researchers and those who manage health services.

Algorithms↗

Air quality in the 21st century: community outreach in North Central Texas.

Public education campaigns, to be successful, must repeat simple, consistent messages over time, using various sources and media. During the 2000, 2001, and 2002 ozone seasons, the North Central Texas Council of Governments (NCTCOG) employed a four-pronged, multimedia approach to educate the public about air quality in the Dallas/Fort Worth (DFW) region. The four-pronged approach included several varied information sources:The new Air Pollution Watch/Warning system based on public health and designed using standard meteorological terminology with notices delivered via e-mail, over the radio, during TV weather forecasts, and on electronic road signs.A revamped Web page, including information about current air quality, ozone exceedances, clean air public meetings, and how to "Do Your Share for Cleaner Air".A PowerPoint presentation used to explain the basics of ozone air pollution, the new Air Pollution Watch/Warning system, and the new Dallas/Fort Worth Clean Air Plan to a variety of constituencies, including the media, scientific/technical/academic groups, elected officials, and community/civic organizations. Newsletter updates, published in the Environmental Resources Department's InsidER (with a circulation of around 1500), to educate and keep the public up-to-date about various air quality issues. This paper provides details about the four-pronged approach, and how it incorporates principles of successful public education campaigns.

Air Pollutants↗

Computer-aided learning for the education of patients and family practice professionals in the personal care of diabetes.

Diabetes Mellitus is approaching pandemic proportions across the globe. It is a disproportionately expensive condition, accounting for 5-9% of annual NHS expenditure. Family practices often play a huge role in the care of diabetic patients. Many GPs elect to play a larger role in diabetes care, but the increasing burden on the multidisciplinary secondary care team means that some of the burden has to fall to family practitioners. In order to provide a high standard of care, the practitioner requires access to continuing education regarding diabetes care. The value of patient education is undisputed. In light of this situation a computer-aided learning (CAL) system is being developed for the education of both patients and practitioners concerning diabetes and its care. The proposed system takes a two pronged approach, being aimed at both patient and practitioner. This interactive system employs multimedia technology to teach practical skills and promote and consolidate theoretical understanding. It is hoped this system will improve patient self-care, and in the long-term reduce the incidence of diabetic complications and their associated costs.

Computer Graphics↗

Teleradiology in Europe.

The new concept of teleradiology is centered on the consideration that it involves management of medical information rather than the simple transmission of diagnostic images from one location to another. Teleradiology must therefore be able to contribute to the seamless integration of the digital environment in which medical data are managed throughout and beyond the hospital, generating value added services for the patients as well as prospective economical benefits for the institution. In this perspective the evolution of telecommunication with the spectacular success of mobile telephony and Internet will play and increasingly important role, by allowing further development in the exchange of multimedia medical information on a regional as well as international level. However, new responsibilities are being given to the radiologists, who must take all necessary technical and organizational actions in order to avoid that the digital management of data may endanger the confidentiality and the integrity of patients' data.

Computer Security↗

Mediated consumer-provider communication in cancer care: the empowering potential of new technologies.

New communication technologies represent a potentially valuable resource for cancer care and education. With the Internet and multimedia programs (e.g. CD-ROMs), health care consumers have access to a wealth of information about cancer and its treatment, can participate in online support groups, and can interact with medical experts across the globe. To be most effective, these interventions must be designed, developed, implemented, and evaluated using a sound conceptual framework that connects factors affecting utilization, the user's experience within the media environment, and post interaction outcomes. This essay presents two health communication frameworks, an expanded model of health care consumer-provider communication and a three-stage model of health promotion using interactive media, to help guide future research and development of innovative technologies for cancer care and education.

Communication↗