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PubMed2000

Web-based continuing medical education (I): field test of a hybrid computer-mediated instructional delivery system.

BACKGROUND: The Internet and the World Wide Web (the Web) present exciting new possibilities for distributing educational materials at a distance and facilitating collaborative learning among geographically isolated physicians. This article provides a brief overview of the Web as an instructional delivery platform and discusses its strengths and weaknesses as a potential medium for enhancing distance learning opportunities for rural and remote physicians. It also describes an innovative hybrid instructional delivery model that was field tested by the Telemedicine Centre to determine its efficiency and effectiveness for providing Web-based instruction. A hybrid model merges the Web and CD-ROMs (compact disk read-only memory) to use several of the more valuable instructional components of Web-based education (i.e., multimedia, interactive forms, hypermedia, and computer-mediated communications). The results of the field test indicate that the hybrid delivery model was an efficient means for delivering computer-mediated continuing medical education instruction on dermatologic office procedures to a group of rural physicians in low telecommunication bandwidth regions.

CD-ROM↗
PubMed2000

Web-based continuing medical education. (II): Evaluation study of computer-mediated continuing medical education.

BACKGROUND: Over the years, various distance learning technologies and methods have been applied to the continuing medical education needs of rural and remote physicians. They have included audio teleconferencing, slow scan imaging, correspondence study, and compressed videoconferencing. The recent emergence and growth of Internet, World Wide Web (Web), and compact disk read-only-memory (CD-ROM) technologies have introduced new opportunities for providing continuing education to the rural medical practitioner. This evaluation study assessed the instructional effectiveness of a hybrid computer-mediated courseware delivery system on dermatologic office procedures. METHODS: A hybrid delivery system merges Web documents, multimedia, computer-mediated communications, and CD-ROMs to enable self-paced instruction and collaborative learning. Using a modified pretest to post-test control group study design, several evaluative criteria (participant reaction, learning achievement, self-reported performance change, and instructional transactions) were assessed by various qualitative and quantitative data collection methods. RESULTS: This evaluation revealed that a hybrid computer-mediated courseware system was an effective means for increasing knowledge (p < .05) and improving self-reported competency (p < .05) in dermatologic office procedures, and that participants were very satisfied with the self-paced instruction and use of asynchronous computer conferencing for collaborative information sharing among colleagues.

Adult↗
PubMed2006

Asian Tobacco Education and Cancer Awareness Research Special Population Network. A model for reducing Asian American cancer health disparities.

Asian Americans are the fastest growing and the second largest foreign-born ethnic group in the United States. Cancer is a leading cause of death among Asian Americans. The Asian Tobacco Education and Cancer Awareness Research (ATECAR) Special Population Network, Center for Asian Health, aimed to reduce or eliminate cancer health disparities in these diverse, underserved populations in Pennsylvania, New Jersey, Delaware, and New York. The ATECAR logic model was adapted from a variety of conceptual frameworks to develop and implement the network's multifaceted cancer health disparities research, training, awareness, and outreach programs. The model was the basis for the developmental phases of the network that included (1) needs assessment, infrastructure, and partnership building; (2) intervention research, training, and mentorship; and (3) evaluation, dissemination, and diffusion. Community involvement occurred at every operational level to ensure program and network sustainability. Between 2000 and 2005, the ATECAR network consisted of 88 partners, representing a cross-section of Asian communities, academia, cancer centers, and health service agencies, ensuring a viable infrastructure for the network's multidimensional cancer health disparities programs. ATECAR's research covered tobacco control, cancer prevention and intervention, and clinical trials. More than 22 research projects were conducted and their results disseminated in peer-reviewed journals. ATECAR also trained 76 junior researchers and special population investigators and 1014 community professionals in disparity issues. ATECAR's multimedia cancer awareness education program reached over 116,000 Asians. The ATECAR network's achievements have had a profound impact on Asian Americans and established a trend toward reducing cancer health disparities, especially among underserved Asian Americans. Cancer 2006. (c) 2006 American Cancer Society.

Asian↗
PubMed2004

A preliminary investigation into the feasibility and efficacy of a CD-ROM-based cognitive-behavioral self-help intervention for bulimia nervosa.

OBJECTIVE: Many patients with bulimia nervosa find it hard to access evidence-based treatment such as cognitive-behavioral therapy (CBT). The aim of the current study was to evaluate the feasibility and efficacy of a novel CD-ROM-based cognitive-behavioral multimedia self-help intervention for the treatment of bulimia nervosa. METHOD: Patients with bulimia nervosa referred to a catchment area-based eating disorder service were offered eight sessions of a novel CD-ROM cognitive-behavioral self-help treatment without any added therapist input. We report here the take-up and drop-out rates and efficacy of this intervention. RESULTS: Of 60 participants who were offered the intervention, 47 took it up. At follow-up, there were significant reductions in binging and compensatory behaviors, most clearly in self-induced vomiting. DISCUSSION: This intervention has potential as a first step in the treatment of bulimia nervosa and for dissemination to nonspecialist settings.

Adult↗
PubMed2004

Computer treatment for common mental health problems.

Perhaps the most complex and controversial role for the computer in clinical practice is as a treatment medium in which the computer effectively replaces the psychotherapist. This article outlines the historical development of computer treatment, from dialogue generators in the 1960s through to the interactive, multimedia programs of the 2000s. In evaluating the most recent developments in computer treatment, we present a small meta-analytic study demonstrating large effect sizes in favor of computer treatments for anxiety and depression for pre/post outcomes and treatment as usual/waitlist comparators. Next, we review studies of the cost effectiveness of computer treatments. Finally, we outline the implications for research, policy, and practice of this new generation of treatment options.

Anxiety Disorders↗
PubMed2003

Design and testing of a virtual environment to train stroke patients with unilateral spatial neglect to cross a street safely.

Virtual reality (VR) entails the use of advanced technologies, including computers and various multimedia peripherals, to produce a simulated (that is, virtual) environment that users perceive as comparable to real world objects and events. In recent years, virtual reality technologies have begun to be used as an assessment and treatment tool in occupational therapy, in part because of the ability to create environments that provide patients with opportunities to engage in meaningful, purposeful tasks that are related to real-life interests and activities. The objective of this study was to determine the suitability and feasibility of using a PC-based, non-immersive, VR system (that is, a system in which the user has a reduced sense of actual presence in and control over the simulated environment) for training individuals with unilateral spatial neglect to cross streets in a safe and vigilant manner. A virtual environment, consisting of a typical city street, was programmed using Superscape's 3D-Webmaster, a 3D web-authoring tool. Twelve subjects, aged 55 to 75 years, participated in the initial feasibility study and, to date, a further eight subjects have participated in the intervention study. Six of the initial subjects and all eight of the intervention subjects had sustained a right hemispheric stroke at least 6 weeks prior to the study. The remaining subjects were healthy age-matched adults who were independently mobile and had no difficulty in crossing streets. The results show that this virtual environment was suitable in both its cognitive and motor demands for the targeted population and indicate that the virtual reality training is likely to prove beneficial to people who have difficulty with crossing streets. The generalizability of these results, and recommendations regarding the use of virtual reality as an occupational therapy intervention, must be substantiated by further studies using a range of VR platforms with people with different cognitive and motor disabilities.

Accidents, Traffic↗
PubMed1995

ARCADIA: a system for the integration of angiocardiographic data and images by an object-oriented DBMS.

Use of data base techniques to store medical records has been going on for more than 40 years. Some aspects still remain unresolved, e.g., the management of textual data and image data within a single system. Object-orientation techniques applied to a database management system (DBMS) allow the definition of suitable data structures (e.g., to store digital images): some facilities allow the use of predefined structures when defining new ones. Currently available object-oriented DBMS, however, still need improvements both in the schema update and in the query facilities. This paper describes a prototype of a medical record that includes some multimedia features, managing both textual and image data. The prototype here described considers data from the medical records of patients subjected to percutaneous transluminal coronary artery angioplasty. We developed it on a Sun workstation with a Unix operating system and ONTOS as an object-oriented DBMS.

Angiocardiography↗
PubMed1996

OncoLink: a cancer information resource for gynecologic oncologists and the public on the Internet.

The Internet is a computer network accessible to over 30 million computers users worldwide. By default, it has become the "information superhighway" that is growing at an explosive rate of between 1 and 2 million new users per month. Internet contains thousands of information of interest to cancer patients and healthcare professionals. Identifying the outstanding "golden" resources from the chaos is difficult. To address this problem and to provide information specific to gynecologic oncology, we developed a cancer information server called "OncoLink" at our institution that is available at no cost 24 hr per day, 7 days per week to all Internet users. OncoLink has two major goals: (1) To provide quality, original content for cancer patients and healthcare professionals and (2) to provide well-organized, consistent access to existing Internet cancer resources. This service may be used by anyone with a Microsoft Windows, Apple Macintosh, or UNIX computer. The service is rich in multimedia content containing text, pictures, illustrations, sound, and video. The information includes (1) original content written by authors at our institution, (2) original content submitted by authors from other institutions and, (3) publicly available information from other resources. Patient-oriented articles, physician-oriented review articles, and NIH, NCI, and FDA documents are available. All content is reviewed by an Editorial Board prior to posting. We have kept a detailed log file of each time the system has been accessed by an Internet user. OncoLink went online in March 1994. During the first 18 months (542 days) of operation, the service received 4,051,901 request for information from 105,589 unique Internet addresses worldwide. There is tremendous public and professional demand for online cancer information via the Internet. We feel that the Internet is an outstanding vehicle for providing quality cancer information for gynecologic oncologist other healthcare professionals, and the public.

Computer Communication Networks↗
PubMed2000

Applications of video mixing and digital overlay to neuroethology.

Neuroethological experiments often require video images of animal behavior and recordings of physiological data to be acquired simultaneously, synchronized with each other, stored, and analyzed together. The use of inexpensive multimedia computers offers new possibilities for mixing video images, analog voltages, and computer data, storing these combined signals to videotape, and extracting quantitative data for analysis. In this paper, we summarize methods for mixing images from multiple video cameras and a Macintosh computer display to facilitate manipulation of data generated during our neurophysiological and behavioral research. These technologies enhance accuracy, speed, and flexibility during experiments, and facilitate selecting and extracting quantitative data from the videotape for further analysis. Three applications are presented: (A) we used an analog video mixer to synchronize neurophysiological recordings with ongoing behaviors of freely moving rats; (B) we used a chroma keyed digital overlay to generate positional data for the rat's face during drinking behavior; and (C) we combined a computer model of a rat's head and whiskers with videos of exploratory behaviors to better track and quantify movements in three dimensions. Although the applications described here are specific to our neuroethological work, these methods will be useful to anyone wishing to combine the signals from multiple video sources into a single image or to extract series of positional or movement data from video frames without frame grabbing.

Animals↗
PubMed2001

Correlates of breast cancer screening among low-income, low-education Latinas.

INTRODUCTION: This paper discusses the factors associated with breast cancer screening among low-education, low-income Latinas. BACKGROUND: These data were collected as part of a breast cancer educational intervention study aimed at this population. The objective of the larger study was to evaluate multimedia methods as an appropriate medium for educating this population of Latinas about breast cancer. METHODS: The study was designed as a field experiment with a pre and posttest design. A total of 1,197 individuals participated in the study, and these were all self-identified Latinas above the age of 40 years who fit the screening criteria of low income and education levels. Of these, 583 individuals provided the baseline (pretest) data on mammogram attitudes, knowledge, and intentions analyzed in this paper. RESULTS: Our results indicate that breast cancer screening knowledge and having a regular doctor were significant factors in ever having had a mammogram and having had a recent mammogram in this sample of low-income, low-education Latinas. Age affected the odds of ever having had a mammogram, but not a recent mammogram. CONCLUSION: Attitudes toward mammography, insurance status, and demographic factors such as foreign birth were not significant predictors of mammography screening in this study.

Adult↗
PubMed1997

The identification of thresholds of acceptability and danger: the chemical presence route.

European Union chemical legislation requires the calculation of local and regional Predicted Environmental Concentrations (PEC) for the assessment of the exposure of new and existing chemicals to aquatic and terrestrial ecosystems. Current methods use local models for air, water and soil to estimate chemical concentrations close to the source and a generic multimedia 'unit world' approach to estimate regional PECs. These models assume generic environmental scenarios representing typical situations in European countries and do not account for the spatial heterogeneity and temporal variability in ecosystem characteristics, soil properties, river flow rates, chemical emissions, etc. The environmental and ecological complexity can best be represented in a Geographic Information System (GIS). By coupling a GIS with a fate simulation model the concentrations of substances in a specific environment are predicted more realistically. The GREAT-ER project (Geography-referenced Regional Exposure Assessment Tool for European Rivers) was launched to refine regional and local exposure assessments for down-the-drain chemicals by applying real, spatial-referenced datasets instead of generic or average values. A modular approach was developed consisting of a hydrological model and a waste-flow, river quality and fate model which are linked to a regional GIS-database. For the calibration and validation in two European study areas representative detergent chemicals (LAS, boron) are used. In a parallel study, high-volume intermediates discharged into the river Rhine are simulated.

Alkanesulfonates↗
PubMed1994

Bioavailability of metals and arsenic to small mammals at a mining waste-contaminated wetland.

In support of a baseline ecological risk assessment evaluating the impacts of mining wastes at the Milltown Reservoir Sediments Superfund site in Montana, a food chain transfer analysis was performed for resident small mammals. Deer mice (Peromyscus maniculatus) and meadow voles (Microtus pennsylvanicus) were trapped from a 200 A portion of a mixed upland and palustrine wetland, and concentrations of As, Cd, Cu, Pb, and Zn in carcass, liver, kidney, and testes were quantified. Concurrent to small mammal trapping, samples of grasses, forbs, and soils were collected and analyzed for metal and As residues. Using a linear multimedia food-chain model, assuming a forage base of wetland vegetation from the site, ingestion of local surface water, and incidental ingestion of soils with vegetation, body burdens of the metals and As in the herbivores were estimated. As a means of estimating potential element bioavailability at the site, the modeled body burdens were compared with measured element concentrations in herbivore tissues. The analysis indicates that the bioavailabilities of As, Cd, Cu, Pb, and Zn were equal to or less than 0.2% for internal organs and 0.1% for carcasses, on a microgram/g tissue wet weight basis. Available site data on soil pH, cation exchange capacity, and extractable elements fraction supported the limited release of soil elements. These results suggest that the bioavailable fraction of mining waste metals in riparian wetland soils may be quite small, and, for the Milltown Reservoir site, lower than originally anticipated.

Animals↗
PubMed1996

Food chain analysis of exposures and risks to wildlife at a metals-contaminated wetland.

A food chain analysis of risks to wetland receptors was performed in support of a baseline ecological risk assessment at the Milltown Reservoir Sediments Superfund site in Montana. The study area consisted of over 450 acres of primarily palustrine wetland contaminated with metals from mining wastes transported from upstream sources (average of 465 mg/kg for Cu in sediments, and 585 mg/kg in soils). The food chain analysis focused on several species of terrestrial and semiaquatic animals indigenous to montane wetlands of the northern Rocky Mountains. Receptors consisted of mice, voles, muskrats, beaver, various waterfowl species, osprey, bald eagles, and deer. Samples of aquatic and terrestrial invertebrates, small mammal tissues, fish tissue, aquatic and terrestrial vegetation, soils, sediment, and surface water were collected and analyzed for As, Cd, Cu, and Zn. A linear multimedia food-chain model was constructed to estimate daily intakes of the metals for each receptor, with assumed values for ingestion of aquatic and terrestrial food items, ingestion of local surface water, and incidental ingestion of soils and/or sediments. Evaluation of health risks to the receptors was performed by comparison of exposures expressed as daily intakes to a suite of toxicity values. The range of values consisted of the lower end of chronic toxicity data found in toxicology databases or the literature for the same or similar species, modified to account for extrapolation uncertainties. Daily intakes of chemicals of concern were below or within the range of toxicity values for all receptors. The weight of evidence from the food chain analysis and earlier bioassessment and ecological studies suggest that the health of the wetland receptors is at minimal risk due to the presence of elevated metals in sediments, upland soils, water, or food items at the site.

Animals↗
PubMedDate not supplied

Changing surgical education strategies in an environment of changing health care delivery systems.

Emerging changes in health care delivery will have a significant impact on the structure of surgical education in academic departments of surgery. Based on some assumptions as to the probable nature of the final product of this reform, this article encourages a proactive stance by surgical educators to anticipate changes and move toward restructuring in areas of curricular content, the teaching process, performance evaluation strategies, and faculty infrastructure of the academic department. Curriculum changes must bridge the gap between public health and medicine and continue the aggressive trend toward teaching in the outpatient setting. Surgical educators must adapt to evolving computer and instructional technology that will make multimedia presentations, distance education, teleconferencing, hypermedia, and virtual reality commonplace in the teaching setting. Increased emphasis on accountability and accreditation will require stringent criteria in performance and program evaluation methodology. The academic infrastructure will need to adapt to the changing goal of training more general surgeons and fewer specialists and yet maintain the fundamental responsibility of an academic surgeon for mentoring the medical student and surgical resident.

Computer-Assisted Instruction↗
PubMed1996

Virtual resource development in the glycosciences.

The development of Internet-based virtual resources is a relatively new area of scientific and technical activity that is currently undergoing rapid expansion. Major factors fuelling recent growth include the emergence of multimedia capabilities through the rapid evolution of the World Wide Web, the reduction in cost of high quality personal computers and graphics workstations and the provision of mass-marketed provider services. Prior to 1995 the presence of Internet resources in the glycosciences was virtually non-existent. Existing scientific knowledge was primarily made available on the Net through the provision of databases from gopher and ftp sites. A particular example in the glycosciences is the Carbbank database of biological carbohydrate sequences. We will describe here our efforts in 1994-95 in establishing The Glycoscience Network (TGN, http:@ bellatrix.pcl.ox.ac.uk/TGN/). These activities included the establishment of a newsgroup, mailing lists, Web resources and the running of the First Electronic Glycoscience Conference (EGC-1, http:@bellatrix.pcl.ox.ac.uk/egc/). EGC-1 included many novel initiatives in the glycosciences including electronic posters and papers, a Virtual Conference Centre, a Web-based hyperglossary, Virtual Trade and Employment Centres, refereed electronic publishing, and the creation of a Virtual Reality Gallery. We would like to look towards the near future and discuss several initiatives in virtual resource creation that we believe will have significant scientific impact on the glycosciences including the development of bioinformatics-based servers, sophisticated interactive databases, and videoconferencing. Furthermore, we cherish the belief that these resources will foster international scientific collaboration and progress of an extent never previously possible. Finally, we indulge in speculation and make some suggestions on the form and long-term impact of Glycoscience Virtual Resources. We predict that their development may completely reconstruct the scientific environment that we work in as scientists and we reflect on the probable benefits and pitfalls to be encountered.

Carbohydrates↗
PubMed1991

The use of graphic design in an interactive computer teaching program.

The widespread diffusion of affordable computers into the scientific and educational community has provided the opportunity to design medical and scientific teaching programs illustrated either by hand or by utilizing commercially available software and manipulating existing computer generated images. The medical illustrator can provide the ideal aesthetic link between text format information and the visual representation of such knowledge in a concise presentation format. The availability of interactive multimedia programs has given the medical illustrator an environment to create and enhance Hypermedia designed specifically for the purpose of medical education. This paper will focus on the incorporation of illustration and screen design into "CT The Game," an experimental medical teaching program currently being developed in the Johns Hopkins Body CT Imaging Laboratory. The program is designed to provide an enjoyable approach to learning Computed Tomography (CT), and is directed toward an audience of medical students, residents, and fellows.

Computer Graphics↗
PubMed1994

Voting and priorities in health care decision making, portrayed through a group decision support system, using analytic hierarchy process.

Within the health care industry many decision making approaches and tools are used. This paper explores a new tool, the Analytic Hierarchy Process (AHP), which permits both subjective and objective information to be considered in a decision. AHP has tremendous potential to solve both traditional and non-traditional health care problems. Its strength as a decision-making tool is its ability to combine both subjective and objective data. Application of AHP is discussed within the context of a Group Decision Support System (GDSS) model developed by Hatcher. The model is reviewed in limited detail, and readers are referred to the original article that defined and discussed the uniqueness and level of sophistication of GDSS applications in the health care industry. Health and medical delivery problems are discussed to highlight AHP requirements and the complexity of AHP applications. Health care applications are unique in that they lend themselves ideally to the use of computer data, image, voice, text, and multimedia concepts.

Decision Making, Organizational↗
PubMed1995

IPI, MEDICOM and DICOM: relations and possible future.

In October 1993, DICOM (Digital Imaging and Communications in Medicine) Version 3.0 was approved by the ACR-NEMA committee as an ACR-NEMA standard for medical image interchange. At about the same time, IPI (Image Processing and Interchange) was approved as an ISO standard for general imaging. Within the European Committee for Standardisation, CEN, work on a European standard for medical image interchange, MEDICOM, has been going on for the last few years. It has been decided within the CEN Technical Committee for Medical Informatics (CEN/TC 251) that such a European standard should be based on IPI. In December 1993 it was also agreed that CEN would use DICOM 3.0 as a starting point in this work. Joint meetings between CEN/TC 251 Working Group 4 (Medical Imaging and Multimedia) and ACR-NEMA have been held held during 1994 and continue in 1995. This paper points to some of the reasons, both technical and economical, why IPI is suitable for medical imaging. It also shows how DICOM and IPI are complementary and that they could be used together to cover the requirements of future applications in medical imaging.

Cardiology↗