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At least 1,009 records · Page 56Linked to original sources
PubMed2001

Teaching clinical informatics to third-year medical students: negative results from two controlled trials.

BACKGROUND: Prior educational interventions to increase seeking evidence by medical students have been unsuccessful. METHODS: We report two quasirandomized controlled trials to increase seeking of medical evidence by third-year medical students. In the first trial (1997-1998), we placed computers in clinical locations and taught their use in a 6-hour course. Based on negative results, we created SUMSearch, an Internet site that automates searching for medical evidence by simultaneous meta-searching of MEDLINE and other sites. In the second trial (1999-2000), we taught SUMSearch's use in a 5(1/2)-hour course. Both courses were taught during the medicine clerkship. For each trial, we surveyed the entire third-year class at 6 months, after half of the students had taken the course (intervention group). The students who had not received the intervention were the control group. We measured self-report of search frequency and satisfaction with search quality and speed. RESULTS: The proportion of all students who reported searching at least weekly for medical evidence significantly increased from 19% (1997-1998) to 42% (1999-2000). The proportion of all students who were satisfied with their search results increased significantly between study years. However, in neither study year did the interventions increase searching or satisfaction with results. Satisfaction with the speed of searching was 27% in 1999-2000. This did not increase between studies years and was not changed by the interventions. CONCLUSION: None of our interventions affected searching habits. Even with automated searching, students report low satisfaction with search speed. We are concerned that students using current strategies for seeking medical evidence will be less likely to seek and appraise original studies when they enter medical practice and have less time.

Computer User Training↗
PubMed1992

Introducing computer literacy skills for physicians.

Computers are integral to medical practice, education, and research. While medical students learn computer skills during their training, many practicing physicians do not have the same computer experience. To familiarize this group with the exciting developments in medical informatics, the Himmelfarb Health Sciences Library and Department of Computer Medicine at the George Washington University Medical Center organized a workshop "Introducing Your Office Computer!" for attending physicians. The workshop featured a short lecture/video presentation on computer applications in medicine followed by a "computer fair" of five computer applications. Eleven physicians attended the workshop. Feedback was very positive; many called later to request more detailed instructions on using the programs demonstrated. It was a valuable experience for the staff, and new bridges were built between departments and clients.

Computer User Training↗
PubMedDate not supplied

Nursing informatics: learning from the past to build a new future.

Health care and health information have been around since the time of Hippocrates or even before. Through the historical evolution, it is observed that the knowledge and information that were simple and easy to learn and retain by that time, became much more complex. This paper presents a brief reviewing on the evolution of nursing informatics and how it grew up and made itself visible during all these years of International Medical Informatics Association (IMIA) conferences.

Forecasting↗
PubMed2001

Undergraduate medical education in Slovakia--present state and future needs.

There is a lot of problems related to undergraduate medical education (UME) at Slovak medical schools, e.g. low level co-ordination and integration of curriculum, isolation of teaching subjects, amateurish teaching methods, low level of management, which result in low level of effectivity, late and insufficient reactions to the needs of medical practice. There is urgent need for complex reform of UME if we like to be able to complete with high quality medical schools in Europe. The reform should be focused to the content of curriculum--to integrate preventive and acute medicine into the UME, to improve training of medical students for service in primary health care, to start with renaissance of humanistic education of medical students, to improve research training and teaching of medical informatics. For improving organisation of UME it is necessary to prepare modern profile of graduates from medical school, and from the profile to derive co-ordinated and integrated system of UME. The teachers at medical school should be professionals not only in medical specialization, but in pedagogy, psychology and management, too. Passive forms of education (e.g. lectures) should be partly substituted by active methods, e.g. problem--based learning. More attention should be devoted to elaboration of criteria for evaluation quality of teaching process. The reform of UME have to be done if we like to have a chance to be as good as the best medical schools in Europe. I believe, we want it all! (Ref. 31.)

Education, Medical, Undergraduate↗
PubMedDate not supplied

[Nozometric algorithms in stomatology].

The intensive development of medical informatics and cybernetics led to the creating of an impressive mathematical apparatus, associated with algorithmization of medical activities and processes. In that aspect, special attention is paid to the nozometric algorithms, applied in the most responsible medical field--therapeutic-diagnostic process. The existing nozometric algorithms are reviewed, with consideration given to the specificity of the stomatological diagnostics. An algorithm set has been systematized that is recommended for use in the field of stomatology.

Algorithms↗
PubMedDate not supplied

[Radiologist-pattern interaction in the processing of fluoroscopic images].

The great complexity of interactions among radiologist, patient and radiological apparatus, when performing radiological tests, is perhaps the main cause of difficulties in the development of automatic systems, both for classification and quantification of radiological images, and for documentation and retrieval of radiological images. The result of such interactions is not a "plate", but a diagnosis, very often the "plate" does not even coincide with the radiological investigation, if this term implies a linkage with the perceptual mechanisms of the radiologist. In other words, the "plate" provides the radiologist with the elements to achieve an interpretation of the image, which will then lead to the diagnosis. In view of a foreseeable spreading of economical medical informatics methodologies, an aim of the present work is stressing the importance of the interactions between medical operators and information processing systems, to select relevant parameters for diagnosis. Sequences of images (originally taken by a movie camera) are presented, which relate to the motor activity of digestive apparatus segments. Processing stresses some of their morpho-dynamic features.

Humans↗
PubMed1997

Assisting maxillofacial surgery by using multimedia VR techniques.

Multimedia and VR technologies are examined as regards their potentiality for medicine, specifically for maxillofacial surgery. The goal is to achieve a surgical procedure of better quality as well as a more interesting way of imparting medical knowledge. Close cooperation with the Maxillofacial and Plastic Surgery Department of the University Hospital Benjamin Franklin (UKBF) ensures the suitability of the material for the user. Doctors give regular feedback on the 3D human-computer interface, graphics and interaction devices because they are crucial for the implementation of multimedia and VR systems in medicine. Before implementing a VR or multimedia application, the technical possibilities should be explored in depth. Therefore, a VR tested for 3D input and output devices has been established at the Technical University of Berlin to assess the advantages and technical restrictions of commercially available and self-made devices. Parts of the VR tested are currently being transferred to the Medical Informatics Department of the UKBF, where the usefulness of various 3D input and output devices for different medical applications in a real clinical environment will be evaluated.

Computer Simulation↗
PubMed2001

Bedside vital signs capture for the non-ICU setting--an open source, PC-based solution.

The efficient and reliable capture of vital signs and other bedside data in the non-ICU setting has been a challenging problem for the medical informatics community. The problem is compounded by the complexities associated with storage of this data into an electronic medical record system (EMRS). There are a lack of off-the-shelf solutions that satisfy the basic system requirements of bedside data capture, user authentication, data validation prior to storage, error handling, and convenience. With the current state of technology available, we feel the solution to this problem requires the presence of a PC with custom interface software at the bedside. This allows for the successful interface between available vital signs capture devices, existing EMRS s, and the user. This report summarizes the alternatives we found and our proposed solution to this important problem.

Computer Security↗
PubMed1998

[Teaching of informatics at the Medical School of Comenius University in Bratislava and its evaluation by students].

In this study we analyzed meanings of students about teaching of informatics at our faculty with aim to improve it. They were asked to complete a questionnaire, which contained questions about organization of teaching, programmes and technical equipment. They had also possibility to suggest their improvements. We sorted the students into two groups according to their previous knowledge and experience in working with computers and then analyzed their answers. The results will be taken into account in further teaching of informatics.

Attitude↗
PubMed1994

Characteristics of health data: structure and relationships.

The characteristics of health data are diverse and vary by discipline. Health data can be viewed from three perspectives. They can be examined at a basic level of different variable types and database constructions. At an intermediate level, the way data are structured in a facility is a model of how an organization works. A computerized information system is a model of how work is performed. An understanding of facility data architecture and data structure is essential for adapting both manual and computerized systems to the rapid changes occurring in health care today. Lastly from the highest-level perspective, for communication and exchange of health data to be possible across all components of the health care delivery system, standards for data must be adopted by all institutions and individuals involved in the development of health data information systems. To expedite such exchange, the American Medical Informatics Association (AMIA) has recommended standards for patient, provider, and site-of-care identifiers; computerized message exchanges; and medical record content and structure. AMIA has also recommended the use of the universal medical language system as the basis for future developments in a universal medical language.

Abstracting and Indexing↗
PubMed1998

Results of European projects improving security of distributed health information systems.

The challenge for improvement of quality and efficiency of health care systems causes the development and promotion of "Shared Care" in all developed countries. Distribution, decentralisation, and specialisation of health care must be joint with an extended communication and co-operation between the different care providers. Fulfilling the shared care paradigm, care supporting health information systems has to be distributed, interoperable, and scaleable too. Communication and co-operation across organisational, regional, and even national boundaries is bearing high threats and risks regarding security and privacy of medical and personal information of both patients and health professionals. Involved in several security projects funded by the European Union, the Medical Informatics Department and the regional Clinical Cancer Registry at the University of Magdeburg are piloting a secure regional distributed medical record system for cancer diseases. Requirements, solutions, and experiences are presented and discussed.

Computer Communication Networks↗
PubMed1997

Using an anesthesia information management system as a cost containment tool. Description and validation.

BACKGROUND: Medical informatics provide a new way to evaluate the practice of medicine. Anesthesia automated record keepers have introduced anesthesiologists to computerized medical records. To derive useful information from the stored data requires programming that is not currently commercially available. The authors describe how they custom-programmed an automated record keeper's database to perform cost calculations, how they validated the programming, and how they used the data in a successful pharmaceutical cost-containment program. METHODS: The Arkive (San Diego, CA) automated record keeper database was programmed at Duke University Medical Center as an independent noncommercial project to calculate costs according to standard formulae and to follow adherence to Duke University Department of Anesthesiology's prescribing guidelines for anesthetic drugs. Validation of that programming (including analysis of discarded drugs) was accomplished by comparing database calculated costs with actual pharmacy distribution of drugs during a 1-month period. RESULTS: Validation data demonstrated a 99% accuracy rate for total costs of the drugs studied (atracurium, vecuronium, rocuronium, propofol, midazolam, fentanyl, and isoflurane). The study drugs represented approximately 67% of all drug costs for the period studied. CONCLUSIONS: Programming of an anesthesia automated record keeper's database yields essential information for management of an anesthetic practice. Accurate economic evaluation of anesthetic drug use is now possible. In the future, as definitive identification of best anesthetic practices that yield optimal patient outcomes and higher measures of patient satisfaction is pursued, large numbers of patients should be studied. This is only possible through database analysis and complete computerization of the perioperative medical record.

Anesthesiology↗
PubMed1994

Beyond clients and servers.

Computer scientists working in medical informatics have to face the problem that software offered by industry is more and more adopted for clinical use by medical professionals. A new challenge arises of how to combine commercial solutions with typical medical software that already exists for some years and proved to be reliable with these off-the-shelf solutions [1]. With the HERMES project, this new challenge was accepted and possible solutions to integrate existing legacy systems with state-of-the-art commercial solutions have been investigated. After a period of prototyping to assess possible alternative solutions, a system based on an indirect client-server model was implemented with help of the industry. In this paper, its architecture is described together with the most important features currently covered. Based on the HERMES architecture, both systems for clinical data analysis and patient care (cardiology) are currently developed.

Computer Systems↗
PubMed2002

Early assessment of medical students' clinical skills.

OBJECTIVE: To provide first-year medical students with a non-threatening, standardized, clinical-skills assessment at the end of the first year (M1CSA), and provide resources to help them build on their strengths and address any weaknesses before starting the second year. DESCRIPTION: Implemented for the first time in April 2001, the M1CSA was designed to help first-year students identify strengths and weaknesses in their developing repertoire of clinical skills. It was composed of five stations (abdominal exam, cardiovascular exam, lung exam, informed consent, social history) and a self-assessment. Each station involved working with a standardized patient (SP), and all SP encounters were videotaped so students could review their work during the self-assessment. The M1CSA was truly formative in nature; there was no passing or failing mark. To help students prepare for the abdominal, cardiovascular, and lung examinations, we distributed via Blackboard(R) an electronic copy of the same exam-skills checklists that the SPs would be using in the exam stations. To facilitate preparation for the social history and informed consent stations, we used Blackboard to provide the scenarios in advance. While students were not allowed to bring these checklists or scenario descriptions into the stations, they did know exactly what was expected. Immediately after each student encounter, SPs completed skills checklists and entered evaluative comments via computer workstations. Upon completing all five stations, students were provided with printouts of the checklists and comments, and proceeded to review their videotapes and write self-assessments indicating specific areas for improvement. Faculty members were available on-site to review portions of the videotapes, answer questions, and offer suggestions. Students also received a resource sheet, which listed faculty members and clinics where they could obtain help developing their clinical skills over the summer months. The M1CSA was designed by a clinical-skills assessment committee and refined through discussion with students. The committee was composed of all four of the first-and second-year clinical skills unit directors, as well as the Patient, Physician & Society course coordinator, the associate dean for medical informatics and computer-assisted learning, the two staff members of Northwestern's Clinical Education and Evaluation Center, the office of medical education's director of evaluation, and the associate dean for education (ex-officio). Students evaluated this first iteration of the M1CSA very positively, and provided useful feedback for making specific improvements. DISCUSSION: The primary motivation for implementing the M1CSA was the fact that, over the past several years, many students reported starting the second year with considerable uncertainty about their clinical skills. The M1CSA was designed to offer a standardized inventory of students' proficiencies, and to encourage continued development in anticipation of working with real patients in the second year. The content reflects a broad view of clinical skills, encompassing communication and ethics, as well as the physical examination. The formative nature of the M1CSA complements the long-standing M2CSA, which is summative (i.e., students must demonstrate proficiency before beginning clerkships).

Clinical Competence↗
PubMed2000

FDA regulation of medical software.

Currently the FDA is reviewing its policy on the regulation of computer software in the medical arena. Healthcare practitioners hope that the FDA will take the least possible regulatory action required by law to fulfill its public health responsibility and will take into account the unique status of the ever-changing software industry. Innovations in telemedicine and medical informatics have yielded significant improvements in the quality and cost of healthcare, and the imposition of cumbersome regulatory requirements on the medical software industry would slow the development and introduction of medical software products.

Software Validation↗
PubMed2003

An inventory of publications on computer-based medical records: an update.

OBJECTIVES: In 1998, we reported a steady increase in the number of publications indexed in MedLine with the MeSH term 'Medical Records Systems, Computerized'. No signs indicating an increasing interest of high-impact medical journals to publish on the computer-based patient record could be determined. In this review we provide an update. METHODS: We retrieved and analyzed all English publications indexed before Feb 22, 2002 in PubMed with the MeSH term 'Medical Records Systems, Computerized'. RESULTS: We retrieved a total of 5856 publications, of which 1824 (31%) appeared in a journal with an impact factor in the year of publication. The total impact-score shows an upward trend. CONCLUSIONS: The results show that the earlier observed increase in number of publications did not persist in the second half of the nineteen-nineties. Since the mid-nineties, there has been a steady yearly production of publications indexed with the MeSH term, reflecting a sustained interest in the domain. However, the volume of publications appearing in journals with higher impact factors is increasing. Furthermore, high-impact journals, such as the "British Medical Journal", the "Lancet" and "Annals of Internal Medicine" regularly publish on the subject, reflecting an interest well beyond the medical informatics community.

Abstracting and Indexing↗
PubMed2004

Universal electronic health record MUDR.

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

Artificial Intelligence↗
PubMed1995

The AMUSE-environment: a didactical environment where active multimedia use stimulates expertise.

The rapidly evolving information technology domain continuously offers new opportunities for computer aided education (C.A.E.). In a pilot project at the Department of Medical Informatics, we studied the possibilities and the limitations of multimedia systems for computer aided education in medicine. Different specialists paid attention to the medical, didactic, conceptual and technical points of view. From this teamwork originated the AMUSE-environment: an environment where Active Multimedia Use Stimulates Expertise. The AMUSE-environment describes a didactic framework that focuses on knowledge acquisition and application in complex content domains (the transfer and stimulation of expertise). In the context of advanced learning and random access instruction, the active involvement of the user is mandatory. Multimedia systems enhance communication by integrating different media (e.g., text, pictures, audio, video, ...) in one natural, user-friendly environment. The first application that uses the AMUSE-environment is developed in cooperation with the Haematology Department of the University Hospital Gasthuisberg. The haematologists filled the didactical framework with more than 500 full color illustrations and corresponding text and audio. The application gives a complete overview of the morphology of the blood and bone marrow cells.

Audiovisual Aids↗