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PubMed2001

Fast education: a comparison of teaching models for trauma sonography.

This study's objective was to evaluate the peritoneal dialysis and mannequin simulator models for the hands-on portion of a 4-h focused abdominal sonography for trauma (FAST) course. After an introductory lecture about trauma sonography and practice on normal models, trainees were assigned randomly to two groups. They practiced FAST on one of the two simulator models. After the didactic and hands-on portions of the seminar, FAST interpretation testing revealed mean scores of 82% and 78% for the peritoneal dialysis and mannequin simulator groups, respectively (p = 0.95). Post-course surveys demonstrated mean satisfaction scores for peritoneal dialysis and mannequin simulator models of 3.85 and 3.25, respectively, on a 4-point Likert scale (p = 0.317). A FAST educational seminar, which provides both didactic and hands-on instruction, can be completed in 4 h; the hands-on instruction phase can incorporate both normal models and abnormal simulation models, such as the peritoneal dialysis model and the multimedia mannequin simulator.

Emergency Medicine↗

PubMed2002

Development and evaluation of an interactive CD-ROM for children with leukemia and their families.

To meet the need for an interactive software product to educate children with leukemia, ages 4-11 years, and their families about the disease and its treatment, we developed and evaluated an interactive, comprehensive, multimedia CD-ROM product, Kidz with Leukemia: A Space Adventure. The prototype was tested using a randomized controlled experimental design. Children with leukemia and their parents were randomized to receive either the newly developed CD-ROM or the book You and Leukemia by Lynn Baker. Health care providers (HCPs) and other content/technical experts evaluated only the CD-ROM. Data were collected on children's health locus of control, their understanding of leukemia, and the satisfaction of participants with their assigned intervention. Children in the CD-ROM group, compared with those in the book group, showed increased feelings of control over their health. Although there was a high level of satisfaction with the CD-ROM among all users, younger children and their parents were most satisfied. In conclusion, the CD-ROM, Kidz with Leukemia: A Space Adventure, was found to be a useful, engaging, and empowering tool for children with leukemia and can serve as a model for developing future health-related educational materials.

CD-ROM↗

PubMed2003

A qualitative study of physicians' perceptions of three decision aids.

The study objective was to investigate physicians' perceptions of three patient decision aids (DA). Semi-structured telephone interviews were conducted with 20 family physicians and 12 gynecologists about a DA for women considering long-term hormone replacement therapy; with 16 respirologists about a DA for the use of intubation and mechanical ventilation for patients with severe chronic obstructive pulmonary disease; and with 19 physicians (geriatricians, gastroenterologists, internists) about a DA for long-term placement of feeding tubes in the elderly. Participants were identified by a snowball sampling technique. The interviews were analyzed using standard qualitative methods. Most participants (81%) indicated some willingness to use the DAs. The characteristics of the DA viewed positively included it being: balanced, well organized, a useful tool, evidence-based, improves decision making process and multimedia. Some of the negative characteristics were stated as: too complex, the cost, the availability, only appropriate for certain groups of patients, and time consuming. The DAs were acceptable to most participants. Perceived positive and negative factors were similar for all DAs. Uptake of decision aids may be facilitated if physicians have an opportunity to examine and try them, and if they can have unfettered access to them for distribution purposes.

Attitude of Health Personnel↗

PubMed1999

Computer-assisted instructions for patients with bronchial asthma.

We produced computer-assisted instruction (CAI) software for bronchial asthma patients (asthma educational system with computer-assisted instruction; ASTCAI) to assist in self-management and avoid asthmatic attacks and death. ASTCAI is a question-and-answer program operating in a multimedia environment, and was evaluated from questionnaires which 33 patients were asked. Thirty-two patients could perform ASTCAI without any assistance. The responses of 31 patients (94%) indicated that they had no difficulty with manipulation, and 29 patients (88%) stated that the program was beneficial to control of their asthma. Elderly patients (over 65) required more time than younger adults. Emergency visits or admissions of at least 1 year after the first CAI trial decreased in eight out of 26 patients, while only two patients deteriorated compared to the previous year. Our results show that CAI is feasible for most patients, and through active self-learning CAI can improve motivation for self-management as well as supplement the physician's instructions.

Adolescent↗

PubMed2000

Watch, Discover, Think, and Act: evaluation of computer-assisted instruction to improve asthma self-management in inner-city children.

An interactive multimedia computer game to enhance self-management skills and thereby improve asthma outcomes in inner city children with asthma was evaluated. Subjects aged 6-17 were recruited from four pediatric practices and randomly assigned to the computer intervention condition or to the usual-care comparison. The main character in the game could match the subject on gender and ethnicity. Characteristics of the protagonist's asthma were tailored to be like those of the subject. Subjects played the computer game as part of regular asthma visits. Time between pre- and post-test varied from 4 to 15.6 months (mean, 7.6 months). Analysis of covariance, with pre-test scores, age, and asthma severity as covariates, found that the intervention was associated with fewer hospitalizations, better symptom scores, increased functional status, greater knowledge of asthma management, and better child self-management behavior for those in the intervention condition. Interactions with covariates were found and discussed in terms of variable efficacy of the intervention.

Asthma↗

PubMed2001

Evaluation of a first aid and home safety program for Hispanic migrant adolescents.

BACKGROUND: Unintentional injuries are the major cause of death among children, adolescents, and young adults. This article presents an evaluation of an injury-prevention program for 11- to 16-year-old, Hispanic migrant youth. DESIGN: Randomized controlled trial with two conditions: first aid and home safety training and tobacco and alcohol prevention. Participants were assessed at baseline, at immediate post-intervention, and at 1-year follow-up. PARTICIPANTS: A total of 660 Hispanic adolescent and parent pairs participated in a program entitled Sembrando Salud (sowing the seeds of health). INTERVENTION: The intervention consisted of two conditions: first aid and home safety training and tobacco and alcohol prevention. Both groups were exposed to an eight-session, multimedia program presented by bilingual, bicultural college students. The sessions consisted of lectures, discussions, and skills development and practice. OUTCOME MEASURES: To examine the efficacy of the first aid and home safety intervention, adolescents were assessed for changes in first aid confidence, knowledge of items in a first aid kit, knowledge of how to respond in an emergency situation, acquisition of a first aid kit, and behavioral skills testing in response to two emergency scenarios. RESULTS: Similar changes in confidence were observed in both groups after the intervention. Participants in the first aid and home safety program were better able to identify items to include in a first aid kit, how to respond in an emergency situation, and reported fewer erroneous victim-caring procedures than the tobacco and alcohol prevention group. CONCLUSIONS: Sembrando Salud was successful at achieving and maintaining change in confidence and knowledge of first aid and emergency response skills over a yearlong period.

Accidents, Home↗

PubMedDate not supplied

Exploring the Visible Human using the VOXEL-MAN framework.

In principle the Visible Human data sets are an ideal basis for building electronic atlases. While it is easy to construct such atlases by just offering the possibility of browsing through the 2D slices, constructing realistic 3D models is a huge project. As one rather easy way to establish 3D use, we have registered the Visible Human data to the already existing 3D atlas VOXEL-MAN/brain. This procedure enables one to lookup anatomical detail in an atlas based on radiological images. Concerning the segmentation problem, which is the prerequisite for a real 3D atlas, we have developed an interactive classification method that delivers realistic perspective views of the Visible Human. As these volume based methods require high-end workstations, we finally have developed a multimedia program that runs on standard PCs and uses Quicktime VR movies.

Anatomy, Cross-Sectional↗

PubMed1999

[New paths for Internet generated learning in anatomy].

For the purposes of a functioning information and knowledge based medicine the conditions for the medical education are crucial. Although multimedia based courses and tutorials via the Internet seem to serve best for a more effective teaching and new didactics, respective anatomical offers in Germany are scarce and thus practice and experience are limited. Only simple digital equivalents of conventional contents and methods can be found, whereas the potencies of the new media are not realized in didactic concepts. Substantial advantages of web based tutorial systems are an intensive use of the feedback possibilities, the opportunity for continuous updating of the contents, the favourable distribution, and faster utilization of improved techniques. This paper introduces the adaptation of different techniques and the development of concepts and notions of modern Internet based teaching by the way of three different events in anatomical education for medical students and doctors. HistoNet 2000 was developed as an interface of lectures, seminars and practical courses in microscopy. The online transmission of a microscopical course as an interactive practical teleteaching was performed by the way of asymmetric data transfer via the ADSL-technology. Multicasting was used as well and has also been applied for the third project. In this multimedial online teaching different specialties were joined together for interdisciplinary courses via the Internet. These new technologies lead to enhanced efficiency in teaching and enlarge the educational offer. Specific Internet adapted teaching and learning projects have to be developed.

Anatomy↗

PubMed2002

Training of residents in peripheral nerve blocks during anesthesiology residency.

STUDY OBJECTIVE: To survey American anesthesiology residency program directors to determine the availability and extent of training in peripheral nerve block techniques. DESIGN: Survey questionnaire was mailed and faxed to 132 American anesthesiology residency program directors and followed up 4 weeks later with another mailing to nonresponders. SETTING: University medical center. MEASUREMENTS AND MAIN RESULTS: Of the 132 American anesthesiology residency program directors surveyed, 69 (52%) responded. Of the responders, 40 (58%) offered a specific peripheral nerve block rotation. The rotation was of 1 month's duration in 61% of these programs. Formal instruction was administered during the rotation in 69%. The regional instruction approach consisted of a nerve stimulator (98%), paresthesia (75%), and transarterial (85%). Multimedia, mannequins, and cadaver dissection were used infrequently (13-25%). During the rotation, residents performed a variety of blocks, but the number of each block varied from 2 (supraclavicular) to 10 (axillary). These blocks were performed in the operating room in 48% of programs. Finally, in the programs with a specific peripheral nerve block rotation, residents were evaluated. CONCLUSIONS: Specific peripheral nerve block rotations are not always included in anesthesiology residents' curriculum. In addition, residents in programs with a specific nerve block rotation are exposed to a greater number of peripheral nerve block techniques than those who do not have such a rotation included in their curriculum.

Academic Medical Centers↗

PubMed2000

Utilization of a commercial prostate brachytherapy planning system for 3D treatment planning of ophthalmic tumors.

The 3D brachytherapy transperineal ultrasound implant (B3DTUI) program by the Multimedia Medical System has been adopted for eye plaque treatment planning. The post op CT digitization option was selected to enter the actual seed coordinates present in the eye plaque. Although the B3DTUI algorithm is designated to calculate a permanent dose values, the described procedure allows determination of the dose distribution as the dose rate values. The dose computation program utilizes updated source quantities recommended by the AAPM TG-43 formalism, such as air kerma strength, dose rate constant, radial dose function, and anisortopy factor function. As a result, more accurate dose distribution in the target is obtained than by using traditional dose computation formalism.

Brachytherapy↗

PubMed2002

Shaping the experience of behavior: construct of an electronic teaching module in nonpharmacologic analgesia and anxiolysis.

RATIONALE AND OBJECTIVES: The authors' purpose was to develop an electronic teaching module in nonpharmacologic analgesia and anxiolysis for use in the radiology department. MATERIALS AND METHODS: The teaching document was derived from previous training courses validated by patient outcome. Skills in structured empathic attention and guidance of self-hypnotic relaxation were tested in a previous prospective, randomized study with 241 patients and shown to affect positively patients' perception of pain and anxiety. Patients undergoing hypnosis had the greatest relief and most hemodynamic stability. The skills applied also saved, on average, 17 minutes of procedure time and approximately $340 in sedation cost per case. With these validated behavioral skills, an electronic teaching module was constructed. RESULTS: The mode of teaching reflected the content of teaching, which was achieved through a multimedia format containing text, audio, video, pictures, and animation. Advanced navigation tools put the students in control of their learning experience. Inclusion of experiential components, congruity of language with Ericksonian syntax, and provision of an electronic journal catered to the development of greater biobehavioral awareness. CONCLUSION: Electronic teaching modules for biobehavioral skill training are feasible and promise to reduce the time need for life interactions with instructors.

Adaptation, Psychological↗

PubMed2001

Implementation and evaluation of a multifunctional telemedicine system in NTUH.

In this article, we proposed a multifunctional telemedicine system supporting both telediagnosis and teleconsultation services. We attempted not only to insure that the implementation of this system satisfied most requirements, but also to evaluate the impact of the system. With regard to system architecture, we designed a unified multimedia database to store all types of data and used two kinds of network (ATM and ISDN) for different possible applications. As for data transmission, the REFRESH and PREFETCH mechanisms were implemented to enhance data transfer efficiency. A total of 1107 consultations employing the telemedicine system were performed during the past 3 years. This technology was used most frequently for radiology consultation (32.7%, n = 362) and ultrasonic examination (19.5%, n = 216). An evaluation of the impact on diagnosis (507 valid cases) indicated that the diagnosis in 80 cases (15.78%) were altered on the basis of second opinions from a medical center; and the number of patients transferred to the medical center was reduced from 24 (4.7%) to eight cases. Most of the rural-site physicians (97%) thought that they did benefit from specialists' experience and knowledge via the telemedicine system. Based on 431 valid questionnaires, the number of the patients with confidence in the telemedicine system at their local healthcare center increased from 72.6% to 87.5%. Overall, more than 90% of patients and physicians believed that the system was valuable and provided satisfactory services.

Adolescent↗

PubMed2001

Medical support system for continuation of care based on XML web technology.

In this paper, the implementation of an Internet-based telematic service for medical support is presented, which was developed and operated in pilot form within the INTRANET HEALTH CLINIC project--a 2-year project supported by the European Commission under the Health Telematics Programme. The aim of the application is to offer high quality care to users of health services over inexpensive communication pathways, using Internet-based, interactive communication tools, like remote access to medical records and transmission of multimedia information. The XML technology was employed to achieve customised views on patient data, according to the access rights of different user profiles. Strict security and access control policy were implemented to ensure secure transmission of medical data through the Internet. The system was designed to collaborate with existing clinical patient record systems and to be adjustable to different medical applications. Current implementations include the fields of Oncology, Lupus Erythrematosis, Obstetrics and Chronic Obstructive Pulmonary disease. The results of the pilot operation with oncological patients in Greece were encouraging, so that the refining of the system and its expansion to a large number of patients is already in progress.

Continuity of Patient Care↗

PubMed2002

An open, component-based information infrastructure for integrated health information networks.

A fundamental requirement for achieving continuity of care is the seamless sharing of multimedia clinical information. Different technological approaches can be adopted for enabling the communication and sharing of health record segments. In the context of the emerging global information society, the creation of and access to the integrated electronic health record (I-EHR) of a citizen has been assigned high priority in many countries. This requirement is complementary to an overall requirement for the creation of a health information infrastructure (HII) to support the provision of a variety of health telematics and e-health services. In developing a regional or national HII, the components or building blocks that make up the overall information system ought to be defined and an appropriate component architecture specified. This paper discusses current international priorities and trends in developing the HII. It presents technological challenges and alternative approaches towards the creation of an I-EHR, being the aggregation of health data created during all interactions of an individual with the healthcare system. It also presents results from an ongoing Research and Development (R&D) effort towards the implementation of the HII in HYGEIAnet, the regional health information network of Crete, Greece, using a component-based software engineering approach. Critical design decisions and related trade-offs, involved in the process of component specification and development, are also discussed and the current state of development of an I-EHR service is presented. Finally, Human Computer Interaction (HCI) and security issues, which are important for the deployment and use of any I-EHR service, are considered.

Abstracting and Indexing↗

PubMed2003

A real time collaboration system for teleradiology consultation.

Real time collaboration systems, in which participants share multimedia data and applications in real time, have attracted many researchers in recent years. A teleradiology consultation system based on the real time collaboration technology is presented in this paper. Under the platform-independence consideration, Java technologies are employed to construct the system. Applying this system, an off-duty on-call radiologist can make diagnoses and report easily by viewing the transferred images at home. Owing to the accessibility of image, all users can examine and manipulate images consistently such that a secluded hospital can be assisted to hold remote consultation. To reduce the network transmission time, the command-passing and local command execution techniques are utilized to achieve the screen synchronization. A pointer function is also developed to maintain the cursor consistency in a more efficient manner during consultation when a detail indication of the examined image is needed. Besides, a dialog window is also designed for on-line conversation. Since Java programs can run on heterogeneous platforms, the need for system maintenance and user training can be substantially reduced.

Internet↗

PubMed1998

Integrated medical informatics with small group teaching in medical education.

National Taiwan University College of Medicine (NTUCM) introduced small groups of teaching and basic-clinical integrated courses for medical students in 1992. By using computer network and multimedia techniques, this study tried to overcome barriers to learning in small group teaching. The Department of Medical Informatics of NTUCM established campus networking and computer classrooms and provided Internet and intranet network services including mail, netnews, bulletin board systems (BBS), world wide web (WWW), gopher, ftp and local file servers. To implement an interactive learning environment, the authors first tried mail lists, newsgroups and BBS. Next an integrated learning system prototype on the WWW was developed to provide functions including online syllabus, discussion boards simulated to BBS, online talk, interactive case studies, virtual classroom with video on demand (VOD) and Internet medical resources. The results showed that after the medical students completed the required course of medical informatics and had good network access using a network to communicate with each other became a daily practice. In the future, the system will extend to the tutoring of clinical practice and continuing medical education. The authors expect a national medical education network and more international cooperation and exchange.

Curriculum↗

PubMed1998

Developing curriculum in nursing informatics in Europe.

The NIGHTINGALE Project (NIGHTINGALE Project: HC1109 DGXIII Contract and Technical Annex, European Commission, December 1995) which started on the 1st of January, 1996, after the approval of the European Commission, has a 36 month duration. It is essential in planning and implementing a strategy in training the nursing profession in using and applying healthcare information systems. NIGHTINGALE contributes towards the appropriate use of the developed telematics infrastructure across Europe by educating and training nurses in a harmonious way across Europe in the upcoming field of nursing informatics. NIGHTINGALE develops courseware material based on the curriculum development process using multimedia technologies. Computer based training software packages in nursing informatics will be the basis of the training material and the corresponding courses. CD-ROM based training and reference material will also be provided in the courses whereas the traditional booklets, teaching material and textbooks can also play an adequate role in training. NIGHTINGALE will disseminate all information and courseware material freely to all interested parties through the publications of the proceedings of the conferences, through the establishment of the world wide web (WWW) server in nursing informatics for Europe (http://www.dn.uoa.gr/nightingale), which will become a depository of nursing information knowledge across Europe as well as a dissemination node of nursing informatics throughout the European members states for the benefit and welfare of the European citizen.

CD-ROM↗

PubMed1998

Computers in the Faculty of Health Science--5 years on.

In 1989, the Faculty of Health Science at Central Queensland University (CQU) committed itself to a major instructional development project for its nursing education program. Partially supported by a National Priority (Reserve) Fund (NPRF) grant, the Faculty undertook a multi-year project to develop computer-based learning materials. The success of that project was mixed. However, by 1993 staff and students within the Faculty were using computers regularly, many of the staff were involved in developing computer-based instructional materials, and some staff were using available computer-based tools to extend the scope of the standard Health Science materials developed under the project. As well, the Faculty was committed to using Faculty funds for technical support staff to maintain its computer infrastructure and to assist both staff and students in using that infrastructure. The authors review the original NPRF project, then explore the Faculty's continued development and use of computer-based learning materials through an examination of student and staff evaluations, personal recollections, and subsequent projects. This paper demonstrates that the NPRF project spawned a number of other computer-based developments, including the offering of health informatics degree programs at the undergraduate and postgraduate levels, the development of the Faculty's current Internet site and a CD-ROM based interactive multimedia project for diabetes education. It also demonstrates that moderate levels of funding can maintain a computer-literate Faculty which views computers as essential tools for learning.

Australia↗