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PubMed2001

The evolution of filmless radiology teaching.

PURPOSE: The transition from hard-copy film to the picture archiving and communication systems (PACS) arena is often a long and difficult path, but the complete transformation to the digital environment does not end with the successful clinical practice utilizing PACS. The next hurdle for academic institutions is similar changes in the teaching field. The loss of hardcopy films can greatly hinder the radiology teaching file and teaching conference experiences. The next step in our growth is the conversion to digital teaching files and conferences. The original work 10 years ago with utilizing computers linked with laser disks and magneto-optical media, have now evolved into complex networks with expanding and relatively cheap storage media, such as CD-ROM and easily to navigate graphic-user interfaces such as hypertext markup language (HTML) and extensible markup language (XML), for use with multimedia teaching tools. CONCLUSIONS: The transition into the digital arena for radiology education and interdepartmental conferences can be accomplished through several different paths. These include direct transfer of images into a presentation program, as well as exportation of images into suitable image file formats for later use. There is also the ability to expand the PACS network to include conference rooms. Similar training and teaching can allow radiologists to transition into the digital environment for future digital teaching file creation as well as correlative radiology interdepartmental conferences.

Computer-Assisted Instruction↗
PubMed2005

[Use of fragrances. What about the side effects?].

Fragrances are increasingly used in private and public domains. Over recent years the olfactory sense has been paid more and more scientific and economic attention. While on the one hand bad smells are counteracted by fragrances, marketing experts are now trying to introduce this sense into multimedia-based experiences. Technical means are used to address positively and directly the sense of smell. The aim is to make the smell a unique feature for a certain brand or location. When it comes to "style of living" or "special shopping experience" nowadays the olfactory design plays an important role. Although fragrances are applied very frequently, there is still a lack of knowledge about the potential consequences for health and the environment. Certain substances (musk compounds) have been proven persistent and accumulative, and others belong to the most common causes of contact eczema. Some people also report special sensitivities towards certain smells for unknown reasons. Unlike audiovisual attractions it is very difficult for humans to avoid olfactory stimuli. The question arises whether fragrance materials constitute a group of substances that should receive more attention concerning their risk for health and the environment.

Allergens↗
PubMed2006

[E-learning in the education and training of physicians. Methods, results, evaluation].

E-learning has been established in the education and training of physicians in various types: linear sequential and hyper-textual forms of multimedia presentations and texts, tutorial systems and simulations. Case-based e-learning systems are of special importance in medicine because they allow for mediation of process and practical knowledge by presentation of authentic medical cases in a simulated environment. The integration into the medical education and advanced professional training is crucial for the long-term success of e-learning; in case-based systems this can be accomplished by blended learning approaches which combine elements of traditional teaching with e-learning. Learning management systems (LMS) support integration of traditional teaching and e-learning by serving as an organizational platform for content of teaching. Further, they provide means of communication for trainers and trainees, authoring tools, interactive components, course management and role-based sharing concept. The dissemination of e-learning can be fostered by attention to requirements and user analysis, early adoption to organizational structures, curricular integration and continuous cooperation with students. Summarized, didactic and organizational aspects determine the success of our own e-learning offers as well as they influence the general further development of e-learning more than technical features.

Computer-Assisted Instruction↗
PubMed1997

[Computer-based training--a new method in surgical education and continuing education].

Computer-based training (CBT) programs teach the material of a specific field and at the same time offer various ways of objectively checking the knowledge gained. The interactive use of multimedia components, such as text, graphics, animation, sound, digital slide shows, videos and quizzes, facilitates the learning process. The aim of this study was the development and evaluation of a CBT program for use by surgeons teaching students. Using SuperCard, a teaching module for distal radius fracture (DRF) was developed, containing detailed clinical information. Video clips and vivid animation combine theoretical knowledge with practical experience. Fourth-year medical students (n = 103) were tested after using the module for 90 min. Other students (n = 47) served as the control group. In a 90-min lecture, DRF was discussed. In all evaluated criteria (distinctness, detailed description, presentation of materials, structure, motivation to learn, time saved while learning and memory retention), CBT gained 15-20% better scores than the lecture. Although 87% of the students stated that their experience with computers was limited or insufficient, 100% found the use of CBT systems helpful in student teaching. Most of them suggested the use of such programs as a exam preparation/self study method (90%) or as a supplement to a lecture (40%). Based on these evaluations, it is clear that CBT modules are an appropriate future teaching and learning system that will be well accepted. In conclusion, CBT programs should be integrated into medical education as a valuable supplement. With this aim, CBT systems should be developed and used at universities as an information system for the surgical residency program.

Achievement↗
PubMed2001

[Teaching and learning in surgery--The Gottingen curriculum].

The study of medicine in Germany is in need of reform. Oversubscribed courses, the lack of practical reference, scarce patient contact and cancelled lessons define the educational landscape for many students. Since at present we cannot carry out global reforms, the quality of medical education is highly dependent on the commitment of those responsible in the individual institution. The aim of the revised surgical curriculum in Göttingen is to demonstrate how medical education with a high didactic level including multimedia teaching can be realised despite large student numbers. Duties both in patient care and education are coordinated through integrated organisation. Educational content and structure are made transparent by online guidebooks. In the surgical examination course and the practical course in surgery, patient-oriented tuition takes place consistently in small groups. The Teaching Studio provides additional aids such as interactive CD-ROMs, online research, textbooks, ultrasound equipment, examination and suturing dummies. Curriculum-relevant information, including the weekly case examples and instruction guides for clinical practical experience, is presented on an Internet website. Constant evaluation of the curriculum not only documents student motivation, but also serves to improve the educational concepts on a continuous basis. On completion of the practical course in surgery, 65% of participants maintain that they have reached the defined learning objectives "well" or "very well" (prior to reform only 17%). In the summer semester 2000, 46% of students gave top marks in the practical course in surgery with respect to tuition in patient contact. The results of the evaluations verify the positive feedback from the student body.

Clinical Competence↗
PubMed2001

[A new concept for integration of image databanks into a comprehensive patient documentation].

Image processing and archiving are of increasing importance in the practice of modern medicine. Particularly due to the introduction of computer-based investigation methods, physicians are dealing with a wide variety of analogue and digital picture archives. On the other hand, clinical information is stored in various text-based information systems without integration of image components. The link between such traditional medical databases and picture archives is a prerequisite for efficient data management as well as for continuous quality control and medical education. At the Department of Orthopedic Surgery, University of Berne, a software program was developed to create a complete multimedia electronic patient record. The client-server system contains all patients' data, questionnaire-based quality control, and a digital picture archive. Different interfaces guarantee the integration into the hospital's data network. This article describes our experiences in the development and introduction of a comprehensive image archiving system at a large orthopedic center.

Computer Systems↗
PubMed2003

[Evaluation of radiological teaching programs in the Internet].

PURPOSE: Evaluation of web based training programs, which can be contacted from the homepages of radiological departments of German universities. MATERIAL AND METHOD: From June 2000 to January 2002 the 75 web based training programs of 57 providers,which can be contacted from the web pages of the radiological departments of German universities were evaluated in a prospective study. A medical student experienced in using the world wide web examined each training program three times in an interval of six months using the following criteria: availability of the web sites, target group, kind of training program, contents and structure and the technical solution. RESULTS: 51 of the 57 the homepages were fully available at each visit. 64 of the 75 web based training programs which could be connected from these sites were available at all three visits.One program was only partially available at one spot check. 8 of the 75 programs were designed for physicians and medically trained personal, 23 were made for medical students and 44 addressed both target groups (partially more than once mentioned). The number of the presented cases ranged between one single and 3700. In 31 of 75 training programs links to other teaching files were found. A complete presentation of cases was presented by 48 of the 75 web sites.5 of the 75 web sites offered physiological images for comparison. In 20 training programs the pathological changes were optically marked in the x-ray images. A logical and didactical structure was found in 24 teaching files, 14 gave the possibility to check the learning results. No provider made use of the possibility to pass credits to the students or physicians account with regard to official training programs. Multimedia techniques were used in 15 training programs.43 sites used data reduced preview images (thumbnails). The latest update of the site is mentioned in 55 of the 75 web sites. 19 of 57 providers had either no possibility of contact or did not answer to an e-mail. CONCLUSION: From the homepages of the departments of diagnostic radiology of German universities 75 teaching files can be contacted. There is a great variety in quantity and quality. Most sites offer collections of cases. A web based training program which is comparable in quality to a CD-ROM teaching program could not be found. No program used the possibility to give credits to the users with regard to official training programs.

Computer-Assisted Instruction↗
PubMed1997

[Multi-media presentation of radiologic image data with the Internet].

AIM: Recent developments of the Internet (World Wide Web) allow the integration of audio, video, digital film sequences, and three-dimensional data. The applicability of these innovations for medical documentation is demonstrated. METHODS: Our existing software for medical image processing and 3D reconstruction was extended to provide images, film sequences, and complex 3D models in an Internet-compatible data format. RESULTS: The multimedia results of the image processing were integrated into Internet documents. Specialized programs are no longer necessary for visualization. The Internet software allows for user-friendly handling and interactive presentation of the 2D and 3D data. CONCLUSIONS: The Internet offers public-domain software for display of images, audio/video, and 3D data. Thus, the tools of the Internet represent an ideal basis for local hospital information systems, computer-aided medical education, and teleconferencing.

Computer Communication Networks↗
PubMed1999

FORUM: Enforcement Lessons from the Vienna Übahn.

/ This paper combines a review of recent publications on the effectiveness of environmental enforcement in the United States with new data to address the question of what type of enforcement activity is most productive. Using data on 39 state National Pollutant Discharge Elimination System (NPDES) programs, the measures of effort and cost typically applied to environmental enforcement and inspection activities were tested for relationships with compliance outcomes. No statistically significant relationships were found. In the absence of any improving trend in traditional measures of compliance, this lack suggests all enforcement systems presently used by states are failing. To work, an environmental enforcement system needs to include maintenance and restoration of compliance, real deterrence, mobilization of public opinion, minimal obtrusiveness, conformity with legal search requirements, cost-effectiveness for all parties, effective primary role for skilled inspectors, self-monitoring, compatibility with environmental management systems (e.g., ISO 14000), environmental auditing, robustness in the face of changing strategies by permittees, segregation of technical assistance from enforcement, team orientation, adaptability to multimedia, and, most difficult of all, disconnection from today's timely, appropriate, proportionate standard. These goals can be achieved through a proposed new environmental enforcement approach built on infrequent, random, but thorough inspections leading to fully documented enforcement actions resulting in high penalties. The enforcement system used by the Vienna Übahn, or subway, can serve as a model for this type of environmental enforcement system. KEY WORDS: Enforcement; Deterrence; Environmental water quality; Discharge elimination systems

Journal Article↗
PubMed2001

Evaluation of clinical relevance of problem-oriented teaching in undergraduate anatomy at the University of Pretoria.

Problem oriented medical curricula claim to be based on the fact that the clinical sciences facilitate and encourage the understanding of basic sciences. The question was asked whether the correlation of gross anatomy in the Abdomen Block in the new Pretoria medical curriculum, with clinically relevant content (i.e. relevant physical examination, imaging anatomy, clinical procedures, clinical presentations and clinical case studies) facilitates the understanding of human anatomy and enhances the development of the clinical thinking fundamental to clinical practice. The clinical anatomy component of the Abdomen Block (11 weeks duration) in the third year was developed by using standardized patients, cadaver material, skeletons, X-rays, CT scans, MRIs and multimedia programs. Student perceptions were assessed by a Likert scale questionnaire. Most students thought that integrating the physical examination enhanced their understanding of the relevant anatomy (mean: 3.55). A substantial number of students thought the clinical anatomy in the block laid a good foundation for imaging anatomy of the abdomen (mean: 3.41). The majority of students thought the clinical anatomy laid a good basis for the understanding of surgical procedures relevant to the abdomen (mean: 3.63). Students were mostly confident that clinical anatomy enhanced their understanding of clinical presentations (mean: 3.68). Although slightly fewer, the majority reckoned that the clinical case studies gave them a better understanding of the relevant anatomy (mean: 3.30). It seems evident that the integration of clinically relevant content facilitates and encourages the understanding of anatomy and thus aids in the development of clinical thinking.

Anatomy↗
PubMed1999

World Wide Web and Internet: applications for radiologists.

Global exchange of information is one of the major sources of scientific progress in medicine. For management of the rapidly growing body of medical information, computers and their applications have become an indispensable scientific tool. Approximately 36 million computer users are part of a worldwide network called the Internet or "information highway" and have created a new infrastructure to promote rapid and efficient access to medical, and thus also to radiological, information. With the establishment of the World Wide Web (WWW) by a consortium of computer users who used a standardized, nonproprietary syntax termed HyperText Markup Language (HTML) for composing documents, it has become possible to provide interactive multimedia presentations to a wide audience. The extensive use of images in radiology makes education, worldwide consultation (review) and scientific presentation via the Internet a major beneficiary of this technical development. This is possible, since both information (text) as well as medical images can be transported via the Internet. Presently, the Internet offers an extensive database for radiologists. Since many radiologists and physicians have to be considered "Internet novices" and, hence, cannot yet avail themselves of the broad spectrum of the Internet, the aim of this article is to present a general introduction to the WWW/Internet and its applications for radiologists. All Internet sites mentioned in this article can be found at the following Internet address: http://www.univie.ac. at/radio/radio.html (Department of Radiology, University of Vienna)

Humans↗
PubMed2000

[On line ophthalmologic education. Live transfers and on demand lectures via Internet].

Continuing medical education for ophthalmologist is important and demanded from the board of ophthalmic organizations. The use of new multimedia possibilities provided by the internet, offers an alternative to acquire the training sessions requested by the board. Aim of the paper is to show the efforts made, to place an internet-based training website for ophthalmologists by transferring live ophthalmology events via the internet. The live-transfers of selected lectures is realized by transferring the original sound compatible to the software "Real-Audio-Player" with an rate of 8000 Hz (encoding-depth 14 bits). By using this software it is possible to follow the lectures live. It includes also 2 live-pictures of 2 digital camcorders to show the appropriate slides from the lecturer. The live broadcasted lectures were afterwards revised and are available at any time as "on-demand lectures" with original sound and slides. Since November 1997, 15 continuing medical education events for ophthalmologists of the University Erlangen-Nürnberg, Germany and from other universities were live broadcasted covering all aspects of phthalmology can be viewed as "on-demand lectures" with original-sound and slides under the internet-addresse http:¿www.onjoph.com/deutsch/live.html. The broadcasted events of workshops were watched via the internet with the appropriate software by 3500 persons, and approximately 5200 persons were listening at least one of the lectures since 1997.

Education, Medical, Continuing↗
PubMed2001

[Retinoscopy. A multi-media teaching program on CD].

INTRODUCTION: Retinoscopy is a classical method to determine the refraction of the eye by observing the dynamics of reflexes and varying the experimental parameters until a specific reflex (neutralisation point) is observed. Until now photographs and geometrical drawings of the different ray tracings have been commonly used to visualise the pathways. We intend to use new media such as video and CD to offer the students a better understanding of retinoscopy. METHODS: With the aid of appropriate experimental devices, retinoscopal reflexes of artificial and human eyes are recorded on video. The video sequences are converted in computer files and together with computer animations of the geometrical ray tracings, text files and audio sequences, they are stored in a suitable CBT-programme. RESULTS: The systematically prepared computer compatible contents offer a modern individually controllable method to perform the instruction programme by multimedia. The CBT-program and the specific files are stored on CDs or can be distributed on the internet. A collection of retinoscopy records of patients, some with extraordinary reflex phenomena is also available. DISCUSSION: Video and animation procedures are more suitable for matching the dynamic phenomena on retinoscopy than photographs or drawings as they offer a more direct basis for understanding of the sometimes difficult processes of retinoscopy. The collection of recorded reflexes also offers the direct visualised experience of particular patient findings such as the appearance in context of implanted spherical and aspherical intraocular lenses or the irregularities of the optic system of eyes with keratokonus.

Computer-Assisted Instruction↗
PubMed2001

[Internet-based teaching and learning in ophthalmology].

The transmission of clinical knowledge occurs traditionally through lectures, theoretical and practical courses, bed-side teaching as well as case-oriented teaching in small groups. The realisation is, however often very laborious and problematical because of low resources. For these reasons the development of computer-based, and in particular internet-based tutorials have increased dramatically in recent years. Furthermore, the transmission of knowledge by means of internet-based tutorials offers several advantages. The content can be quickly updated and multimedia presentations are possible. The use of these sources is normally independent of time and location. The possibilities of internet-based teaching and learning are on-line lectures, case simulations and online quizes. At present, the number of ophthalmological applications on the internet is still restricted. Internet-based multimedial tutorials represent a meaningful supplement to traditional forms of teaching. Especially in ophthalmology, a visual presentation of details can be performed in an easier way via multimedial tools and the training is followed without causing stress for the patients.

Computer Graphics↗
PubMed2000

[Telematics in geriatrics--potentials, problems and application experiences].

Modern telecommunication technology (telematics) has the potential to improve the quality of life for elders with physical and mental impairments as well as for their care giving relatives. Videophones, internet resources, and multimedia computers can be used for networking them together with social workers, nurse practitioners, physicians and therapeutic staff in service-centers. This can be viewed as a unique opportunity to establish and maintain instant and personalized access to various medical services in a situation where increasing needs are opposed to decreasing resources. However, it is not yet clear whether telematics is adequate, efficient, and effective in supporting care for geriatric patients. Some studies already showed its applicability and feasibility, but there are still no larger trials showing that maintenance or enhancement of autonomy can be achieved effectively by using new technologies. This article reviews the literature on telematics in geriatrics and presents data of a tele-rehabilitation project ("TeleReha", conducted at the Berlin Geriatric Center) which comprised mobility-impaired patients (N = 13, mean age 72 yrs), care giving relatives (N = 8), and geriatric professionals. Networking was established using ISDN technology with videophones or PC-based videoconferencing systems. Results showed that participants regard telecommunication devices as a valuable resource for their informational and communicational needs. Use of telecommunication systems was inversely related to physical mobility. Having access to professional service and counselling was rated highly important but also the opportunity to establish reliable contacts with non-professionals (relatives, other participants). Despite experienced technical problems, use of telecommunication systems was evaluated more positively in the post-test as compared to the pre-test. In summary, current experience suggests that telematics can be used efficiently by geriatric patients and by relatives and professionals caring for them. However, evidence for a medically and economically effective use is still scarce. A lack of structural and organizational concepts for geriatric telematics initiatives can be identified which in part may be due to the fact that the considerable potentials of telematics applications are still largely unrecognized by geriatricians.

Aged↗
PubMed2007

European dissemination of a web- and case-based learning system for occupational medicine: NetWoRM Europe.

OBJECTIVE: Occupation has a large impact on health in Europe. In order to prevent and recognize occupational diseases, medical students and physicians should know about the potentially causal relationship between profession and diseases as well as the basic legal aspects of occupational medicine (OM). However, the opportunity of bedside teaching, the students' most favoured way of teaching, is limited. METHODS: One possibility to complete and improve traditional training in OM is computer-oriented case-based learning. Using the authoring system "CASUS" (INSTRUCT AG) cases can be created and handled without knowledge in computer sciences. RESULTS: So far, 19 cases have been created and evaluated by students of German universities. Due to the great efforts arising from the creation of such multimedia cases it is desirable and cost-effective to use the existing cases at several medical universities. Therefore, the Net-based Training in Work-Related Medicine (NetWoRM) project shares cases on an international base. In February and April 2005, 13 case-authors from 12 centres were trained in the basics of case creation during a 3 week programme in Munich. The overall evaluation of the participants indicated that this way of teaching case creation is very efficient. Up to now, nine cases were translated into English and five into Spanish. First implementation of the cases in Spain and Finland showed a good acceptance by the students but more evaluation has still to be done. CONCLUSION: Based on these results we conclude that exchange of case-based e-learning in OM is feasible and rewarding on an international base.

Case-Control Studies↗
PubMed1997

Segmentation of moving images by the human visual system.

New segments appearing in an image sequence or spontaneously accelerated segments are band limited by the visual system due to a nonperfect tracking of these segments by eye movements. In spite of this band limitation and acceleration of segments, a coarse segmentation (initial segmentation phase) can be performed by the visual system. This is interesting for the development of purely automatic segmentation algorithms for multimedia applications. In this paper the segmentation of the visual system is modelled and used in an automatic coarse initial segmentation. A suitable model for motion processing based on a spectral representation is presented and applied to the segmentation of synthetic and real image sequences with band limited and accelerated moving foreground and background segments.

Algorithms↗
PubMed2004

Live broadcast of laparoscopic surgery to handheld computers.

BACKGROUND: Thanks to advances in computer power and miniaturization technology, portable electronic devices are now being used to assist physicians with various applications that extend far beyond Web browsing or sending e-mail. Handheld computers are used for electronic medical records, billing, coding, and to enable convenient access to electronic journals for reference purposes. The results of diagnostic investigations, such as laboratory results, study reports, and still radiographic pictures, can also be downloaded into portable devices for later view. Handheld computer technology, combined with wireless protocols and streaming video technology, has the added potential to become a powerful educational tool for medical students and residents. The purpose of this study was to assess the feasibility of transferring multimedia data in real time to a handheld computer via a wireless network and displaying them on the computer screens of clients at remote locations. METHODS: A live laparoscopic splenectomy was transmitted live to eight handheld computers simultaneously through our institution's wireless network. RESULTS: All eight viewers were able to view the procedure and to hear the surgeon's comments throughout the entire duration of the operation. CONCLUSION: Handheld computer technology can play a key role in surgical education by delivering information to surgical residents or students when they are geographically distant from the actual event. Validation of this new technology by conducting clinical research is still needed to determine whether resident physicians or medical students can benefit from the use of handheld computers.

Audiovisual Aids↗