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PubMedDate not supplied

Active index for content-based medical image retrieval.

This paper introduces the active index for content-based medical image retrieval. The dynamic nature of the active index is its most important characteristic. With an active index, we can effectively and efficiently handle smart images that respond to accessing, probing and other actions. The main applications of the active index are to prefetch image and multimedia data, and to facilitate similarity retrieval. The experimental active index system is described.

Abstracting and Indexing↗
PubMedDate not supplied

A 3D medical image database management system.

We describe the design and implementation of QBISM (Query By Interactive, Spatial Multimedia), a prototype for querying and visualizing 3D spatial data. Our medical image application is focused on the brain mapping requirements for multimodality relationships across multiple subjects. It incorporates data describing both structure and function. It includes data structures that describe anatomy, physiology, coordinates using rendered imagery and statistical output. The system is built on top of the Starburst DBMS extended to handle spatial data types, specially, scalar fields and arbitrary regions or space within such fields. In this paper we list the requirements of the application, discuss the logical and physical database design issues, and present timing results from our prototype. We observed that the DBMS' early spatial filtering results in significant performance savings because the system response time is dominated by the amount of data retrieved, transmitted, and rendered.

Brain Mapping↗
PubMedDate not supplied

An Internet atlas of mouse development.

A prototype two- and three-dimensional color atlas of mouse development is described. The prototype has been developed using two embryos, a 13.5 d normal mouse embryo and a PATCH mutant embryo of the same age. Serial sections of the embryos, with an external registration marker system, introduced into the paraffin embedding process, were prepared by standard histological methods. For the 2D atlas, color images were digitized from 100 consecutive sections of the normal embryo. For the 3D atlas, 300 gray scale images digitized from the mutant embryo were conformally warped and reconstructed into a 3D volume dataset. The external fiducial system facilitated the three-dimensional reconstruction by providing accurate registration of consecutive images and also allowed for precise spatial calibration and the correction for warping artifacts. The atlases, with their associated anatomical knowledge base, will be integrated into a multimedia on-line information resource via the Internet's World Wide Web (WWW) using an enhanced (patent pending, Eòlas Technologies) version of the Mosaic WWW browser program from the National Center for Supercomputer Applications. These programs will provide research biologists with a set of advanced tools to analyze normal and abnormal development.

Anatomy, Artistic↗
PubMedDate not supplied

The fetal imaging workstation demonstration project.

Congenital birth defects are a leading cause of infant mortality. Early detection of fetal anomalies by prenatal ultrasound may improve clinical outcome in selected cases. However, many training programs are hindered by curriculum weaknesses which include: (1) limited physician exposure to ultrasound anomalies; (2) inadequate postnatal correlation with prenatal findings; (3) constraints imposed by static images for ultrasound training; and (4) difficulty with understanding complex three-dimensional anatomy. The Fetal Imaging Workstation Demonstration Project addresses these problems by illustrating how computers can supplement traditional prenatal ultrasound training through interactive multimedia. The project uses a laserdisc library of ultrasound video images as source material for a variety of interactive software tutorials. An educational testing module has been developed that can evaluate diagnostic skills through simulated ultrasound studies provided by the laserdisc library. An interactive three-dimensional fetal heart model also provides a new way for physicians to better understand their two-dimensional ultrasound studies. A survey suggests that this prototype has been widely accepted by housestaff physicians and that there is a perceived need for this supplementary training. Future work will address the educational effectiveness of these materials and will consider cost-effective ways to disseminate the software for other institutions. However, future development must be implemented against a background of rapidly emerging technologies involving faster computers, digital video, and virtual reality applications.

Computer Systems↗
PubMed2003

Collaborative environment for clinical reasoning and distance learning sessions.

BACKGROUND: The medical curriculum has changed with the adoption of the student-centered learning paradigm. Clinical reasoning learning (CRL) is used in order to develop and improve students' clinical reasoning and problem-solving skills. PURPOSE: We have observed that, in complement to traditional CRL sessions, students commonly consult resources available on the internet. Based on this observation, our objective is to create computer tools to coordinate CRL sessions at distance, integrating these electronic resources at every step of the reasoning process. MATERIAL AND METHODS: In order to create the system, we elaborated an object-oriented model of a computer-supported collaborative learning environment. The proposed system includes a local web-server to store electronic resources and a relational database to store their electronic addresses (urls). JAVA was used as the programming language. RESULTS: We developed a set of cooperative platform-independent tools. This environment includes a communication tool. Multimedia data exchange is possible. Information is shared thanks to an electronic notepad and whiteboard tools. PERSPECTIVES: This learning environment will be integrated in the French Virtual Medical University project, and is intended to be used for undergraduate, internships, residency or continuing medical education.

Computers, Handheld↗
PubMed1998

Use with care: possibilities and constraints offered by computers in nursing clinical education.

Funding constraints, demands for improved efficiency, low staff to student ratios and improved computer software (D. Wright, The use of multimedia computers and software in nurse education, Health Inf. 1 (3) (1995) 101-107.) all combine to produce a situation where a dramatic increase in the use of CBE for tertiary nurse education appears inevitable. In particular there is a very strong movement towards the development of nurse education materials able to be delivered via the World Wide Web (WWW). Given the speed and the extent of these developments it is essential that CBE developments are subject to adequate review and critique. In particular it is important that the pedagogical concepts under pinning the CBE are congruent with the technological innovation being implemented. This paper provides such a review and critique through the discussion of a project concerned with the integration of a computerised hospital nursing care planning database into the undergraduate nursing curriculum. The evaluation of the project not only raises many issues and concerns relevant to CBE in general, but also provides examples of the ways in which CBE can be used to link theory to practice. It also highlights the need for congruency between pedagogy, technology and student learning. Implications arising from the project are discussed at length, including the possibility for clinicians and academics to work collaboratively on database development.

Computer-Assisted Instruction↗
PubMed2000

The reliability and internal consistency of an Internet-capable computer program for measuring utilities.

OBJECTIVE: The purpose of this study was to assess the reliability and internal consistency of measurements of utilities performed with a computer program (iMPACT2) designed for Internet surveys and Internet patient decision-support systems. METHODS: We implemented the Internet Multimedia Preference Assessor Construction Tool, version 2 (iMPACT2) program using the combination of a web server, HTML files, and a web-accessible database. The program randomized subjects, screened their responses for missing data and failures of internal consistency, assisted patients with resolving certain inconsistencies, and, upon a subject's completion of the protocol, provided a report of results to the research assistant administering the program. To validate the iMPACT2 program, we recruited 60 healthy community volunteers and elicited preferences in a research-lab setting using a visual analog scale (VAS) and the standard gamble (SG) for subject's current health and three hypothetical states. For purposes of comparison, we also administered a Short Form-12 (SF-12) health-assessment questionnaire. Subjects used the computer software on two occasions separated by 2-4 weeks of time. RESULTS: Visual analog scale and standard gamble ratings for subjects' current health were reliable (intraclass correlation coefficient (ICC) of 0.82 and 0.84 (two outliers excluded -0.60 without exclusions), respectively) were comparable with the reliability of the Physical and Mental Component scales of the SF-12 (ICCs of 0.84 and 0.75, respectively). Subjects could easily discriminate between hypothetical states (D scores 0.74 for SG and 0.90 for VAS), and 94% had a completely internally consistent ordering of preference ratings for states. CONCLUSIONS: iMPACT2 produces measurements of standard gamble utilities that are reliable and have a high degree of internal consistency. Procedures for assessment of utilities developed for desktop computer programs can be translated to software designed for the Internet, facilitating the use of utilities and endpoints in clinical trials and development of web-based decision-support applications for patients. However, further testing, including direct comparisons with traditional interviewer administered utility elicitation protocols, is needed.

Analysis of Variance↗
PubMed1998

Computer-assisted creation of psychiatric advance directives.

Results are reported from a project that involved design, production, and feasibility testing of the use of a multimedia computer program to: 1) educate MH consumers about psychiatric advance directives (ADs), and 2) assist them in creating ADs. The feasibility results, based on a random sample of 60 adults meeting criteria for having a serious and persistent mental illness, were positive. Sixty-five percent of the sample were able to complete their ADs. Educational level, presence of a learning disability, and minority-group membership, but not diagnosis, were related to completion rates. The results dispel several popular myths about psychiatric ADs.

Adult↗
PubMed1997

The effect of assessment method and respondent population on utilities elicited for Gaucher disease.

Measured preferences have been reported to vary with the method of elicitation and respondent population surveyed. We elicited utilities for Gaucher disease using a multimedia implementation of the time trade-off, standard gamble, and a conceptually different, largely untested approach, the risk-risk trade-off, from those who are healthy, those with a chronic illness and those with Gaucher disease. The risk-risk trade-off produced significantly lower utilities than the other two preference assessment methods and had the poorest test-retest reliability. The respondent's self-rated current health state utility was the most important determinant of utility values elicited by the time trade-off and standard gamble for the hypothetical health states. Our results do not support the use of our implementation of the risk-risk trade-off method. In eliciting preferences for hypothetical health states from the general population, the subjective rating of a respondent's own health state should be considered in determining representative population groups.

Adult↗
PubMed2001

Computer assisted learning. A review.

Since 1980 the amount of medical information has doubled approximately every second year. This implies that oral health students as well as professionals need to manage the flow of information rationally, in order to learn how to undertake evidence-based decision-making for diagnosis and treatment in a given patient situation. Current research indicates that computer connected databases and computer assisted learning (CAL) may enhance learning and provide the clinician with information for decision-making when treating patients. Multimedia for CAL, which combines audio and visual data in an interactive form, has proved to be an effective tool in education. CAL may supplement and reinforce more traditional learning and create opportunities to illustrate clinical situations in an interactive way. CAL has the potential to help students develop skills and knowledge. Students, staff and professionals consider CAL stimulating and motivating. Students easily adapt to CAL although their current computer literacy is still low. New authoring tools make it easier for faculties to develop their own CAL software. In the future we will see more sophisticated software with virtual patients who can communicate and interact with the student in a very realistic way. The software will even "step out" from the screen and help the student with clinical procedures. However, at present CAL should not replace traditional education, but rather be used more as a supplement and for self-directed studies.

Attitude↗
PubMed2003

Teaching oral surgery to undergraduate students: a pilot study using a Web-based practical course.

The Internet has been used in oral surgery teaching mainly to deliver learning material across the World Wide Web and to make use of online interactivity resources in everyday surgical practice, such as by e-mails, discussion groups, and chats. The aim of this paper is to describe and evaluate a Web-based practical course on oral surgery principles, which was applied to undergraduate students. This course was investigated as a distance learning simulation in which the student would be performing surgical activities at home, and the teacher and the school environment would be absent. A Web site was created containing the course material. For this study, the students participated in the Web-based course in a multimedia lab equipped with computers and Internet, internal sound system and TV circuits. In the event of significant mistakes by students, the TV circuit could be used to show the correct procedure for all the participants at the same time. Microcameras were used to monitor the student's actions during the Internet use. Students' impressions were determined by a questionnaire. Computer manipulation with ease and antiergonomic postures were observed. We concluded that distance learning courses with practical modules must be considered as a special type of educational modality, with reference to the relationship between the student and the computer.

Adolescent↗
PubMed1996

Initial experience of the ORATEL computerised information tools in general practice.

ORATEL (a telematic system for quality assurance indicators in oral health care) is a three-year project with the ultimate objective of improving the quality of oral health care through the use of appropriate computerised information systems. These tools are designed to promote quality assurance and quality of care development in oral health care by using common quality indicators/standards. ORATEL has developed three prototypes of computerised information systems: an interactive multimedia teach software on quality assurance in oral health care, ORATEL-TEACH; a proactive quality assurance support tool for real time use at the dental unit, ORATEL-PROACT; and an integrated set of modules for monitoring and self assessment at the clinical level and for the computerised reporting of aggregated data for evaluation at higher levels, ORATEL-REVAL. The initial experiences of using these tools was assessed during 1993 in general dental practice locations in Liverpool and clinics in for other European countries. Overall, the dentists were positive about the potential usefulness of the ORATEL tools but further improvements were considered necessary. Finding has been approved by the European Commission for further development under a new project called ORQUEST.

Computer Communication Networks↗
PubMed1999

Developments and challenges in family practice nutrition education for residents and practicing physicians: an overview of the North American experience.

The history of nutrition education in family medicine residency training and continuing medical education (CME) in North America is briefly reviewed. Past efforts have been successful in improving knowledge and attitudes toward nutrition. Some of the barriers to physicians providing nutrition services to their patients, such as poor reimbursement for those services, are largely outside the domain of medical educators. However, the education and training of family practice residents and practicing physicians in nutrition has not yet fully matured. Strategies are needed that impact physician counseling behaviors. Strengthening the content of certification examinations, providing evidence that brief counseling strategies impact patient outcomes, and role modeling counseling through multimedia delivery are three educational strategies with potential.

Attitude of Health Personnel↗
PubMed2003

Health outcomes assessment in vulnerable populations: measurement challenges and recommendations.

With growing recognition that some population subgroups are particularly vulnerable to receiving suboptimal health care and achieving poor health outcomes, innovative techniques are required for collecting and evaluating health outcomes data. Research is also needed to better understand the causal pathways linking vulnerability with health outcomes. This article focuses on patients with a chronic illness (cancer) who also have low literacy and/or poor English language skills. We summarize the association among literacy, language, ethnicity, and health outcomes; describe innovative technologies to enhance communication; and discuss the advantages of using psychometric measurement models in health outcomes assessment. Results from our ongoing research projects are presented, including the development of an audiovisual computer-based testing platform for self-administration of questionnaires. Such innovative multimedia technologies allow patients with limited or even no reading ability to participate in outcomes assessment and have the potential to be incorporated into a clinical setting with minimal burden on staff and patients. Appropriate methods are also needed to evaluate measurement equivalence across diverse patient groups, that is, the extent to which items in a questionnaire perform similarly across groups. Item response theory measurement models provide a strategy for differentiating between measurement bias and real differences that may exist between groups. Recommendations for clinical practice and research are offered specifically to address medically underserved and vulnerable populations.

Activities of Daily Living↗
PubMed2001

[Principles and advanced techniques for better internetpresentations in obstetrics and gynecology].

Internet presentations are common tools for better medical communication and better scientific work. Meanwhile a great number of gynecological and obstetrical institutions present data via the world wide web within a wide range of quality and performance. Specific HTML editors offer quick and easy presentations, but only advanced internet techniques enable interesting multimedia presentations. N-tier applications are the future standard and we must integrate them in general informatical systems. New Concepts, actual tools and general problems will be discussed and new principles similar to actual E commerce techniques are able to solve our special medical demands.

Computer Security↗
PubMed2000

The role of informatics to support evidence-based practice and clinician education.

This paper reports the results of a national event held during November 1998 to educate health professionals representing multiple disciplines about evidence-based practice (EBP), its implementation and the use of informatics to support EBP. A combination of educational delivery methods and multimedia was used. Through local group work, participants identified obstacles to EBP implementation and developed strategies to overcome these in their own local environments. Major and common findings were a lack of management support and infrastructures needed for the successful adoption of evidence-based practices by all.

Australia↗
PubMed2005

A simple system for producing, recording and broadcasting lectures and presentations.

Taking lecture notes has been the traditional starting point for revision; but in a high-tech age why miss important points whilst attempting to slowly transcribe a lecture, when we have the means to record it? This report aims to summarize information that may be used by anyone to provide good-quality, cost-effective provision of information via multimedia online lecture-materials. By applying and teaching simple techniques we can all ensure that each faculty and its students are exposed to the best of the wide world of online education, training and success.

Computer-Assisted Instruction↗
PubMed2000

Case-based support in a cooperative medical diagnosis environment.

Many medical services are often not available to people living in remote areas because of the lack of medical specialists. This problem would be alleviated if a suitable environment was designed to allow physicians to collaborate and exchange ideas with centrally located medical specialists. This article describes an ongoing research project to design and implement a collaborative multimedia environment to allow medical specialists to cooperate in diagnosis. The environment will support remote database access for medical images, the retrieval of relevant medical cases to support diagnosis, and communication among participants through telepointers and image annotation by free-hand drawing.

Cervical Vertebrae↗