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Medical informatics and problem-based learning in conjunction.

At Dalhousie, we integrated medical informatics as a horizontal theme in the problem-based learning undergraduate medical education curriculum. The rationales for these initiatives can be addressed along the following dimensions: political, philosophical, psychological, educational, and professional practice. Student attitudes towards computers are changing, and incoming students are increasingly computer-literate. Of those Med I students surveyed at the end of the 1993-94 academic year, 94% felt that computers were moderately important or essential to medical education; 86% of Med II students surveyed were of the same opinion. The education of future physicians can be enhanced when medical informatics is introduced into a curriculum in conjunction with the problem-based learning approach.

Attitude to Computers↗

Neural networks: a new technique for development of decision support systems in dentistry.

OBJECTIVES: To outline the key concepts of neural network based systems and to evaluate the potential applications of such systems in dentistry. DATA SOURCES: Published work on neural networks. CONCLUSIONS: Neural networks may initially seem complex and computer intensive, but actually integrate well with a clinical environment. Neural network expert systems may be trained with only clinical data and as such can be used where 'rule based' decision making is not possible. This is the case in many clinical situations. Neural networks may therefore become important decision making tools within dentistry and have applications both in improving clinical care and in maximizing the cost benefit of care.

Algorithms↗

"THE PILOT": a tool for connecting existing HIS to an extranet quickly, easily and smoothly.

Migrations and expansions of information systems are constantly at the front line of all the computer science problems to be overcome in medical / health informatics systems. It is shown here that one effective way to open the communication between heterogeneous systems is depending upon the ease of putting all the systems at work together using the middleware level to facilitate the interconnection between heterogeneous applications. However the most difficult application to migrate is certainly the ADT. It is shown here how the Pilot could facilitate the migration of applications namely with the migration of the ADT itself from a centralized platform to a full scale distributed system. Indeed the Pilot has been developed up to the stage of a pre-product and is on sale already. It has been experienced satisfactorily and is presented here.

Computer Communication Networks↗

[Informatics and parenteral and enteral nutrition: the state of the art].

A review was performed of the progress made with the assistance of computers in the parenteral and enteral nutrition field as one more of the many uses made today of the computer industry. Detailed analysis is presented by the authors of the different types of hardware used, as well as the main characteristics and content of the programmes and applications existing in this field, both restricted to small working groups and in management. A comparative study was also made of the management programmes distributed free of charge by some laboratories. Finally, an evaluation was made of the advantages and disadvantages of using computers in parenteral and enteral nutrition at present.

Computers↗

Strategies for the use of computers in health care. Symposium on information technology as a tool in health care. Linkoping, 27-28 October 1987.

The fact that I have used for this article the title proposed by the organizers of this conference does not mean that I agree with the philosophy which inspires it: a philosophy of means instead of a philosophy of finalities. Indeed, the use of computers in health care is not unavoidable simply because computers do exist. This is a mistake that has frequently been made since the beginning, and which is probably the source of most of our illusions and delusions. Computers are tools, and no more, and we must and can resist the 'instrumental reason' criticized in depth by philosophers such as R. Garaudy [1], M. Henry [2], E. Morin [3], and scientists like J. Weizenbaum [4]. I would prefer to reverse the question of how to use computers in health care and answer the following ones: What are the main information problems in medicine and health? and What is the part of computer technology in their solution? Connected to these questions is the consideration of the mental, intellectual, cultural, and even ethical impact of the machinery on its designers and users. With regard to the latter, I will mention the benefits of a better methodological education and the threat of an excessive rationalistic drift. This ethical consideration will lead me back to a brief discussion of 'instrumental reason'. This discussion will thus provide guidelines and caveats rather than true strategic recommendations. It will deal with attitudes more than with specific actions. Indeed, we cannot escape some kind of consideration of our humanity, and the mutual relationship between technology and our existence and actions.

Electronic Data Processing↗

Information and informatics literacy: skills, timing, and estimates of competence.

BACKGROUND: Computing and biomedical informatics technologies are providing almost instantaneous access to vast amounts of possibly relevant information. Although students are entering medical school with increasingly sophisticated basic technological skills, medical educators must determine what curricular enhancements are needed to prepare learners for the world of electronic information. PURPOSE: The purpose was to examine opinions of academic affairs and informatics administrators, curriculum deans and recently matriculated medical students about prematriculation competence and medical education learning expectations. METHODS: Two surveys were administered: an Information Literacy Survey for curriculum/informatics deans and a Computing Skills Survey for entering medical students. RESULTS: Results highlight differences of opinion about entering competencies. They also indicate that medical school administrators believe that most basic information skills fall within the domain of undergraduate medical education. CONCLUSIONS: Further investigations are needed to determine precise entry-level skills and whether information literacy will increase as a result of rising levels of technical competence.

Computer Literacy↗

Informatics in Radiology (infoRAD): Magnetic Resonance Imaging Workbench: analysis and visualization of dynamic contrast-enhanced MR imaging data.

Magnetic Resonance Imaging Workbench (MRIW) allows analysis of T1- and T2*-weighted dynamic contrast-enhanced magnetic resonance imaging data sets to extract tissue permeability and perfusion characteristics by using standard pharmacokinetic models. Parametric maps are calculated from individual pixel enhancement curves in regions of interest (ROIs) and displayed as color overlays on the anatomic images. User-defined ROIs can be saved to ensure consistency of later reanalysis. Individual parametric maps are visualized together with user-selected parameter time-series plots. The following selections are available: overall ROI enhancement curve and fit, histogram, and individual pixel enhancement curve and fit. Summary data (transfer constant, leakage space, rate constant, integrated area under the gadolinium curve after 60 seconds, relative blood volume, relative blood flow, and mean transit time) may be exported to permanent storage along with per-pixel results for statistical analysis. Numerical values for parameters are displayed below the plot for easy reference. The dynamic range of plots and parametric map overlays is interactively adjustable. Viewing individual enhancement curves and parametric maps allows radiologists to investigate the heterogeneity of contrast agent kinetics for lesion characterization and to scrutinize serial changes in response to therapy. MRIW is written in IDL, enabling it to be used on a variety of computer systems.

Computer Graphics↗

Continuing education in health informatics in the UK: the need for learning materials.

The case for education in health informatics for all practitioners as well as information specialists has been well recognized [1]. Changes are occurring in the undergraduate medical curriculum in the UK. This can be seen by the general moves towards computer-based teaching in higher education and the recommendations for the new medical undergraduate curriculum by the General Medical Council (GMC). A survey of undergraduate students has shown that there is an increasing level of computer literacy [2]. We need, therefore, to concentrate on postgraduate education. In the UK, postgraduate and continuing education is organized under the auspices of Regional Postgraduate Deans, Regional Advisors in General Practice, and the educational initiatives of the Professional Royal Colleges. Educational guidelines for information management for undergraduates have been described [3] and these guidelines apply to practitioners as well. The main problems in postgraduate education are the scale of the task, the staff, facilities, and teaching materials available. Basic computer literacy will enable practitioners to make use of computers in their own environment and access the "information superhighway" via the Internet. When this becomes a reality, there will be a need for suitable teaching materials to be made available. The accessibility of these materials raises questions about credit for authorship and the production of flexible packages that can be used by different individuals with their own needs in mind. We have a number of educational materials, at different stages of development, that are described here in the hope that we may collaborate in the exchange of teaching materials.

Computer User Training↗

The state of medical informatics in India: a roadmap for optimal organization.

In India, the healthcare delivery systems are based on manual record keeping despite a good telecommunication infrastructure. Unfortunately, Indian policy makers are yet to realize the importance of medical informatics (including tele-health, which comprises e-Health and Telemedicine) in delivering healthcare. In the medical curriculum also, nowhere is this treated as a subject or even as a tool for learning. The final aim of most of the medical and paramedical students should be to become good users, and if possible, also experts for advancing medical knowledge base through medical informatics. In view of the fast changing world of medical informatics, it is essential to formulate a flexible syllabus rather than a rigid one for incorporating into the regular curriculum of medical and paramedical education. Only after that one may expect all members of the healthcare delivery systems to adopt and apply medical informatics optimally as a routine tool for their services.

Computers↗

Learning to consult with computers.

OBJECTIVE: To develop and evaluate a strategy to teach skills and issues associated with computers in the consultation. INTERVENTION: An overview lecture plus a workshop before and a workshop after practice placements, during the 10-week general practice (GP) term in the 5th year of the University of Melbourne medical course. DESIGN: Pre- and post-intervention study using a mix of qualitative and quantitative methods within a strategic evaluation framework. OUTCOME MEASURES: Self-reported attitudes and skills with clinical applications before, during and after the intervention. RESULTS: Most students had significant general computer experience but little in the medical area. They found the workshops relevant, interesting and easy to follow. The role-play approach facilitated students' learning of relevant communication and consulting skills and an appreciation of issues associated with using the information technology tools in simulated clinical situations to augment and complement their consulting skills. The workshops and exposure to GP systems were associated with an increase in the use of clinical software, more realistic expectations of existing clinical and medical record software and an understanding of the barriers to the use of computers in the consultation. CONCLUSIONS: The educational intervention assisted students to develop and express an understanding of the importance of consulting and communication skills in teaching and learning about medical informatics tools, hardware and software design, workplace issues and the impact of clinical computer systems on the consultation and patient care.

Attitude to Computers↗

Establishing an international reference image database for research and development in medical image processing.

INTRODUCTION: The lack of comparability of evaluation results is one of the major obstacles of research and development in Medical Image Processing (MIP). The main reason for that is the usage of different image datasets with different quality, size and Gold standard. OBJECTIVES: Therefore, one of the goals of the Working Group on Medical Image Processing of the European Federation for Medical Informatics (EFMI WG MIP) is to develop first parts of a Reference Image Database. METHODS: Kernel of the concept is to identify highly relevant medical problems with significant potential for improvement by MIP, and then to provide respective reference datasets. The EFMI WG MIP has primarily the role of a specifying group and an information broker, while the provider user relationships are defined by bilateral co-operation or license agreements. RESULTS: An explorative database prototype has been implemented using the MySQL database software on the Web. Templates for provider user agreements have been worked out and already applied for own 'pre-RID-MIP' co-operations of the authors. DISCUSSION AND CONCLUSION: First steps towards a comprehensive reference image database have been done. Issues like funding, motivation, management, provision of Gold standards and evaluation guidelines are to be solved. Due to the interest from research groups and industry the efforts will be continued.

Databases as Topic↗

Medical informatics. The future is here.

Informatics is an indispensable discipline for leaders and managers--of patients, facilities, and organizations--because the most important assets of those organizations are their information processing technologies, and the key skills are those that help them to manage information. Managers and executives will increasingly need to anticipate trends in information management technologies that could affect their business. In health care, computer-based patient records, integration engines, online analytical processing systems, telemedicine, expert systems, and the Internet have become vital to having the competitive advantage. Those who do not understand the promise and limitations of these technologies and the need for strong leadership to establish standards for data and transaction systems will not lead their organizations well.

Computer Communication Networks↗

Medical informatics education.

Medical Informatics is a multidisciplinary field, dealing mainly with informatics and technology applications in health care. Medical Informatics is composed from a number of sub-areas such as computer based patient record (CPR), processing of multimedia information (signals, images), coding and transmission through high speed networks of medical information (telematics), medical decision support systems, data security and integrity, integration of technologies in hospital and regional environments, and development of educational tools. The people who receive such an education are capable of development, integration and maintenance of complex hospital and health information systems both at departmental and regional levels. A very important issue however is the acceptance of information technology (IT) solutions engineered by medical informaticians from the medical personnel. In this paper we shall deal with the set-up of a medical informatics and medical technology educational environment, as well as the areas from medical informatics that the average user needs to be familiar with in order for the successful deployment of IT solutions in health care.

Curriculum↗